Approaches to Pain Management - During In-Office Hysteroscopy Procedures

As an increasing number of OB/GYN practices are beginning to move hysteroscopy procedures into the office, questions about pain management often arise. The last thing providers want is for such procedures to be painful and/or traumatic for their patients. So, having proven pain control protocols in place is essential. In this paper, we’ll explore protocols that have been developed by experts and that have been shown to be effective.

UNDERSTANDING SOURCES AND TOLERANCE OF PAIN

One of the most important things to remember when addressing pain management during hysteroscopy procedures is that there is no one source of uterine innervation. Instead, there are multiple sources and controlling pain effectively requires a tailored approach. Simply using local anesthesia may not be sufficient for every case.

In addition to uterine neuroanatomy, other determinants of how well a patient will tolerate pain include the following:

• The setting in which the hysteroscopy procedure will be performed
• A patient’s previous experience with office-based procedures
• The perceived competence and compassion of the staff
• A patient’s confidence level and personality
• The surgical experience and confidence of the provider

Other than a patient’s confidence level and personality, the remaining factors that influence how well pain will be tolerated are controlled by providers and their staff. All of them should be considered and optimized before establishing an in-office hysteroscopy program.

USING LOCAL ANESTHESIA TO CONTROL PAIN

When using local anesthesia for pain management, patience is key. Giving the anesthetic time to work will help ensure a much more comfortable experience for the patient.

Dr. Malcolm Munro, a gynecologist and Clinical Professor in the Department of Obstetrics & Gynecology at UCLA, has published a systematic review detailing his use of local anesthesia for in-office hysteroscopy procedures. Anesthetic agents discussed include topical anesthetic for the vagina, local anesthetic in the cervix, paracervical anesthetic, topical intracervical agents, topical intracavitary agents and fundal block.