Preemptive Analgesia In Diagnostic Hysteroscopy

Abstract

Walquiria Quida Salles Pereira Primo, Guttenberg Rodrigues Pereira Primo and Carlos Roberto de Resende Miranda

Objective: To evaluate the preemptive analgesic effect of rofecoxib during the performance of a diagnostic hysteroscopy.

Methods: Randomized double-blind placebo-controlled trial. 55 patients were studied; 27 took rofecoxib and 28 took a placebo two hours before the beginning of the procedure. The instrument used to measure pain was a numeric scale from zero to ten, with zero representing “no pain” and ten representing “the worst possible pain.” The patient selected a number to describe the intensity of the pain at five points: before the procedure, during the passing of the hysteroscope through the internal orifice of the cervix, at the distension of the uterine cavity, during the biopsy and at the moment of discharge. The ANOVA (F-test) and the Mann Whitney U-test were used. Statistical significance was set at 5% (p < 0.05).

Results: The results demonstrated that there was no statistically significant difference between the groups at the five evaluated phases when analyzed as a set (F = 1,477; p > 0,231). During the passage of the instrument through the internal orifice of the cervix, the median score given by the patients was 3 in the rofecoxib group and 5 in the control group, with 50% of the ratings distributed among the lower and upper quartiles (3-5 in the rofecoxib group and 3.5-6.5 in the control group). However, there was a statistically significant difference among patients in the rofecoxib group at the moment of “passage of the instrument through the internal orifice of the cervix” (p = 0.004), as well as in pre-menopausal patients (p = 0.002) and those who had normal delivery (p = 0.004).

Conclusions: The use of 50 mg of rofecoxib was not superior to placebo in the alleviation of pain during diagnostic hysteroscopy. Nevertheless, rofecoxib was superior to placebo for pain reduction at the moment of passing the hysteroscope through the cervix for normal delivery and pre-menopausal patients.

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