Conscious sedation for office hysteroscopy: A systematic review and meta-analysis. (November 2021)

• Record Type: Journal Article
• Authors: De Silva, Prathiba M.; Carnegy, Alasdair; Graham, Christopher; Smith, Paul P.; Clark, T. Justin
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 266(2021)
• Page Start: 89
• Page End: 98
• Publication Date: 2021-11
• Subjects: Nitrous oxide -- Benzodiazepines -- Opioids -- Pain -- Sedative -- Outpatient -- Endoscopy; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2021.09.001
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To evaluate the role of conscious sedation on pain control in office hysteroscopy. Methods: MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to the 30th October 2020 in order to perform a systematic review and meta-analysis of all randomized controlled trials investigating women undergoing office hysteroscopic procedures, allocated to either conscious sedation or a suitable comparator, where the outcome was pain. Data regarding adverse events, feasibility and satisfaction/acceptability were also collected. The Risk of Bias 2 tool was used to assess study quality. Standard mean differences (SMD) or Odds Ratios (OR), and their 95% confidence intervals (CIs) were calculated for continuous (e.g. mean pain) and dichotomous (e.g. side-effects) outcomes, respectively. Results: The literature search returned 339 results, of which seven studies were included for systematic review, with five studies having data suitable for meta-analysis. Intravenous conscious sedation, when compared with local anesthesia, reduced pain during (SMD −0.26, 95% CI −0.51 to −0.01), but not after (SMD −0.18, 95% CI −0.43 to 0.07) office hysteroscopy. No significant difference in side-effects were noted (OR 15.58, 95% CI 0.08 to 2891.91). Intravenous conscious sedation, when compared to an oral analgesic and antispasmodic, was associated with increased pain, both during (SMD 1.03, 95% CI 0.56 to 1.49) and after (SMD 0.49, 95% CI 0.04 to 0.93) hysteroscopy and had significantly more side-effects (OR 134.33, 95% CI 16.14 to 1118.17). Inhalational conscious sedation (70% N2 O/30% O2 ), when compared to oral analgesia and anxiolysis, showed the greatest reduction in pain during hysteroscopy (SMD −1.04, 95% CI −1.57 to −0.52), however side-effects were not reported. Whilst patients and hysteroscopists were more satisfied with deeper levels of sedation, resulting side-effects, such as delirium, increased the level of post-procedural attention required, leading to a significantly lower level of satisfaction amongst nursing staff. Conclusion: The routine use of conscious sedation in contemporary hysteroscopic practice should be avoided in the absence of any clear reduction in pain and a higher risk of side-effects.