Pericervical Analgesia Versus Analesia With Nitrous Oxide (N2O) in Outpatien Operative Hysteroscopy With Miniresector

NCT ID: NCT06092541

Last Updated: 2024-05-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-02

Study Completion Date

2024-05-02

Brief Summary

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This research will have the aim of evaluating and comparing the effectiveness of two methods (analgesia with nitrous oxide and pericervical analgesia, excluding the use of paracervical block due to the increased risk of complications reported in the literature in the control of pain caused during Outpatient Operative Hysteroscopy maneuvers with Miniresector.

Detailed Description

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Pain is the primary cause of hysteroscopy failure. It can be attributed to multiple causes, such as manipulation of the cervical canal , uterine distention due to the liquid distension media used during the procedure , operating procedures on the endometrium (as a possible cause of uterine contraction) , until the release of prostaglandins following manipulation of the cervix and uterine distension.

There are few studies in the literature that have compared the various methods of pain control during the hysteroscopic examination. Among these, Ahmad et al., for example, compared the use of the paracervical block and inhalation anesthesia during hysteroscopy: although both proved to be effective in controlling pain, the paracervical block was associated with a greater number of complications. More recently, Solano et al. they defined how the administration of nitrous oxide was equally effective (but with many more advantages) to the paracervical block with 1% lidocaine in controlling pain during hysteroscopy performed using the Bettocchi hysteroscope.

However, for the purposes of this research it is important to take two aspects into consideration:

* all the studies in the literature that compared the various pain control methods during hysteroscopy were conducted using the Bettocchi Hysteroscope and not the Miniresector;
* more in detail, there are no studies comparing the use of nitrous oxide and pericervical analgesia during outpatient operative hysteroscopy with miniresector.

Objective This clinical trial will have the aim of evaluating and comparing the effectiveness of two methods (analgesia with nitrous oxide and pericervical analgesia, excluding the use of paracervical block due to the increased risk of complications reported in the literature1) in the control of pain caused during Outpatient Operative Hysteroscopy maneuvers with Miniresector.

Conditions

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Hysteroscopy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Single-blind, randomized clinical pilot study with masked third-party assessment. Patients will be assigned to the two groups (pericervical analgesia / nitrous oxide) through the sealed envelope method.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The patients, in the database, will be identified as group A and B; Once the study and the compilation of the database have been completed, this will be delivered to the results evaluation team which will therefore be blinded, not being able to recognize whether group A and B belong to control or intervention.

Study Groups

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Intervention group: pericervical anesthesia

Intervention group: pericervical anesthesia

Group Type EXPERIMENTAL

Intervention Group: pericervical anesthesia

Intervention Type DRUG

Patients assigned to the Intervention Group will receive Pericervical anesthesia before performing Hysteroscopy.

Specifically, for the administration of pericervical analgesia, Mepivacaine/Lidocaine 1.5% 10/15 ml (max dose 7 mg/kg) will be used and pericervical infiltration will be performed at 0.5 cm depth at 3 and 9 hours.

Control group: nitrous oxide anesthesia

Control group: nitrous oxide anesthesia

Group Type ACTIVE_COMPARATOR

Nitroux Oxide anesthesia

Intervention Type OTHER

Patients assigned to the Control Group will receive Nitrous Oxide anesthesia before hysteroscopy

Interventions

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Intervention Group: pericervical anesthesia

Patients assigned to the Intervention Group will receive Pericervical anesthesia before performing Hysteroscopy.

Specifically, for the administration of pericervical analgesia, Mepivacaine/Lidocaine 1.5% 10/15 ml (max dose 7 mg/kg) will be used and pericervical infiltration will be performed at 0.5 cm depth at 3 and 9 hours.

Intervention Type DRUG

Nitroux Oxide anesthesia

Patients assigned to the Control Group will receive Nitrous Oxide anesthesia before hysteroscopy

Intervention Type OTHER

Other Intervention Names

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Pericervical Anesthesia N2O2 Anesthesia

Eligibility Criteria

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Inclusion Criteria

* nulliparous or primiparous women (a previous Spontaneous Vaginal Birth -PS- or a previous Cesarean Section -TC- the latter comparable to nulliparous women as no previous cervical dilation -)
* age between 25 and 50 years

Exclusion Criteria

* age \< 25 or \> 50 years
* multiparity
* positive history of previous operations on the cervical canal (e.g. conization)
Minimum Eligible Age

25 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Ospedale degli Infermi di Biella

OTHER

Sponsor Role lead

Responsible Party

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Bianca Masturzo

Head of Obstetrics and Gynecology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Bianca Masturzo, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Ospedale degli Infermi Biella

Locations

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Ospedale degli Infermi

Biella, , Italy

Site Status

Countries

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Italy

References

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Dealberti D, Riboni F, Prigione S, Pisani C, Rovetta E, Montella F, Garuti G. New mini-resectoscope: analysis of preliminary quality results in outpatient hysteroscopic polypectomy. Arch Gynecol Obstet. 2013 Aug;288(2):349-53. doi: 10.1007/s00404-013-2754-7. Epub 2013 Feb 16.

Reference Type BACKGROUND
PMID: 23417150 (View on PubMed)

Ahmad G, Saluja S, O'Flynn H, Sorrentino A, Leach D, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev. 2017 Oct 5;(10)(10):CD007710. doi: 10.1002/14651858.CD007710.pub3.

Reference Type BACKGROUND
PMID: 35611933 (View on PubMed)

Meyer L, Moore J, McMillan L. Outpatient Hysteroscopy in the Management of Abnormal Vaginal Bleeding. J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S30-1. doi: 10.1016/s1074-3804(96)80239-8.

Reference Type BACKGROUND
PMID: 9074183 (View on PubMed)

Zupi E, Luciano AA, Marconi D, Valli E, Patrizi G, Romanini C. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. J Am Assoc Gynecol Laparosc. 1994 May;1(3):249-52. doi: 10.1016/s1074-3804(05)81018-7.

Reference Type BACKGROUND
PMID: 9050495 (View on PubMed)

Solano Calvo JA, Del Valle Rubido C, Rodriguez-Miguel A, de Abajo FJ, Delgado Espeja JJ, Gonzalez Hinojosa J, Fernandez Munoz L, Zapico Goni A. Nitrous oxide versus lidocaine versus no analgesic for in-office hysteroscopy: a randomised clinical trial. BJOG. 2021 Jul;128(8):1364-1372. doi: 10.1111/1471-0528.16657. Epub 2021 Mar 9.

Reference Type BACKGROUND
PMID: 33528862 (View on PubMed)

Del Valle Rubido C, Solano Calvo JA, Rodriguez Miguel A, Delgado Espeja JJ, Gonzalez Hinojosa J, Zapico Goni A. Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study. J Minim Invasive Gynecol. 2015 May-Jun;22(4):595-600. doi: 10.1016/j.jmig.2015.01.005. Epub 2015 Jan 14.

Reference Type BACKGROUND
PMID: 25596171 (View on PubMed)

De Silva PM, Carnegy A, Graham C, Smith PP, Clark TJ. Conscious sedation for office hysteroscopy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021 Nov;266:89-98. doi: 10.1016/j.ejogrb.2021.09.001. Epub 2021 Sep 3.

Reference Type BACKGROUND
PMID: 34600190 (View on PubMed)

Vitale SG, Alonso Pacheco L, Haimovich S, Riemma G, De Angelis MC, Carugno J, Lasmar RB, Di Spiezio Sardo A. Pain management for in-office hysteroscopy. A practical decalogue for the operator. J Gynecol Obstet Hum Reprod. 2021 Jan;50(1):101976. doi: 10.1016/j.jogoh.2020.101976. Epub 2020 Nov 6.

Reference Type BACKGROUND
PMID: 33166706 (View on PubMed)

De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for Office Hysteroscopy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1034-1047. doi: 10.1016/j.jmig.2020.01.008. Epub 2020 Jan 23.

Reference Type BACKGROUND
PMID: 31982584 (View on PubMed)

Schneider EN, Riley R, Espey E, Mishra SI, Singh RH. Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial. Contraception. 2017 Mar;95(3):239-244. doi: 10.1016/j.contraception.2016.09.006. Epub 2016 Sep 9.

Reference Type BACKGROUND
PMID: 27621048 (View on PubMed)

Munro MG, Brooks PG. Use of local anesthesia for office diagnostic and operative hysteroscopy. J Minim Invasive Gynecol. 2010 Nov-Dec;17(6):709-18. doi: 10.1016/j.jmig.2010.07.009.

Reference Type BACKGROUND
PMID: 20955982 (View on PubMed)

Keyhan S, Munro MG. Office diagnostic and operative hysteroscopy using local anesthesia only: an analysis of patient reported pain and other procedural outcomes. J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):791-8. doi: 10.1016/j.jmig.2014.03.006. Epub 2014 Mar 25.

Reference Type BACKGROUND
PMID: 24681061 (View on PubMed)

De Iaco P, Marabini A, Stefanetti M, Del Vecchio C, Bovicelli L. Acceptability and pain of outpatient hysteroscopy. J Am Assoc Gynecol Laparosc. 2000 Feb;7(1):71-5. doi: 10.1016/s1074-3804(00)80012-2.

Reference Type BACKGROUND
PMID: 10648742 (View on PubMed)

The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol. 2020 Mar;135(3):e138-e148. doi: 10.1097/AOG.0000000000003712.

Reference Type BACKGROUND
PMID: 32080054 (View on PubMed)

Ahlbom A. Modern Epidemiology, 4th edition. TL Lash, TJ VanderWeele, S Haneuse, KJ Rothman. Wolters Kluwer, 2021. Eur J Epidemiol. 2021 Aug;36(8):767-768. doi: 10.1007/s10654-021-00778-w. Epub 2021 Jul 3. No abstract available.

Reference Type BACKGROUND
PMID: 34216355 (View on PubMed)

Other Identifiers

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CE 130/2023

Identifier Type: -

Identifier Source: org_study_id

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