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Flexible outpatient hysteroscopy at a district general hospital: Patient's pain relief and satisfaction with a combination of oral and local analgesia
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FC3.22.05 NATIONAL SURVEY OF OUT-PATIENT HYSTEROSCOPY IN THE UK L. Ronerson, S. Duffy, Dept. OBIGYN, St. James’s University Hospital, Leeds, UK. Objectives: The investigation of women with bleeding using outpatient hysteroscopy has been established in a number of units in the UK. The benefit to patients and the Health Service is currently under review. The extent to which outpatient hysteroscopy is available to patients is not clear, possibly due to preferred alternative clinical practice. In 1994. 1995 over 100,000 diagnostic procedures were undertaken for menorrhagia in England alone, with only 30,000 of these performed in the out-patient setting. This survey is designed to explore the current practice in relation to outpatient hysteroscopy with staffing levels, training facilities and equipment used with the underlying reasons as to why it may not be in use. Study Methods: We sent postal questionnaires to all consultant gynecologists in the UK with no reminder sent for non-responders. Results: Of 1148 questionnaires sent 629 were returned (55%) response rate, a previous study in 1996 initiated at Bradford in the UK had a response rate of 43%. The findings relating to the differing practices will be presented in detail but 48% of respondents had an interest in minimal access surgery. 54% had out-patient hysteroscopy available to them and of the ones with no facility 76% would like it instituted. Conclusions: Out-patient hysteroscopy is widely available and in the units where it is not, there is a significant desire for the facility to be initiated. There is a huge variation in equipment, facilities and staffing for out-patient hysteroscopy.
FC3.22.06 FLEXIBLE OUTPATIENT HYSTEROSCOPY AT A DISTRICT GENERAL HOSPITAL: PATIENT’S PAIN RELIEF AND SATISFACTION WITH A COMBINATION OF ORAL AND LOCAL ANALGESIA. A C Paul, Bangladesh Medical College, Dhaka, Bangladesh. M A Debono, Dept. OBIGYN, Halifax General Hospital, Salterhebble, Halifax, U.K. Objectives: To study the effect of oral diclofenac and lignocaine spray to the cervix on level of patients pain relief and satisfaction during outpatient flexible hysteroscopy. Study Methods: From July 1998 to October 1999, patients having outpatient flexible hysteroscopy were invited to participate into this prospective study and 160 of them agreed. For analgesia, they had oral diclofenac and local lignocaine spray. Hysteroscopy was performed with a 3mm flexible hysteroscope. The data was collected from a standardized data collection form filled by the patients immediately after and at 15 minutes of the procedure. A visual analogue chart was used to document pain as mild, moderate and severe. To assess their satisfaction, patients were asked whether they would consider this procedure in future. Results: The most common indication for hysteroscopy was abnormal vaginal bleeding. There were 51(31%) postmenopausal and 59(36%) perimenopausal women with abnormal vaginal bleeding. During the procedure, 44 (27%) women had no pain and in 63(39%) the pain was mild. Moderate pain was complained by 46(29%) and in 7 (4%) the pain was severe. Hysteroscopy was completed in 157(98%) and 155(96%) had endometrial biopsy. At 15 minutes after hysteroscopy, 90(56%) complained of no pain. Mild, moderate and severe pain was reported by 47(30%), 18(11.25%) and 5 (3%) of the women respectively. If required for them, 156(97.5%) of the women will consider this procedure in future. Conclusions: Outpatient hysteroscopy with oral diclofenac and lignocaine spray to the uterine cervix is a well tolerated procedure and highly appreciated by the patients.
WEDNESDAY,
SEPTEMBER
6
FC3.22.07 DOES THE “Y” IN OUT-PATIENT HYSTEROSCOPY MATTER? P. P. MC Gurgan, P O’Donovan, MERIT Centre, Bradford Royal Infirmary, U.K. Objectives: Evaluate the preconceptions and perceptions of patients having out-patient hysteroscopy, with emphasis on their attitudes towards the gynaecologist’s gender. Study methods: Prospective anonymous questionnaire used before and after the procedure for women referred to an out-patient hysteroscopy clinic in a district general hospital, where the surgeon was randomly allocated, and blinded to results. Results: Out patient hysteroscopy was performed on 77 patients, (38 and 39 patients had a male or female surgeon respectively). The two groups of patients were similar in age, parity, ethnicity, referral source and pre-medication use. Fifteen (39%) of the patients allocated to a male, and 9 (23%), of the patients allocated to a female would prefer a female hysteroscopist. This was not statistically significant (p= 0.12), no patients expressed a preference for a male. Gender preference had no significant effect on pre-operative anxiety (p=O.58), or procedure discomfort (p=O.76), or satisfaction (p=O.28). Patients treated by a male were more likely to state that the procedure would have been improved by having a female surgeon (p=O.O54). Conclusions: The preference rates for gender are comparable to other published studies. Patients treated by operators of different genders do not have any difference in discomfort or satisfaction scores, but women treated by men perceive that the procedure would be improved if they were treated by a female operator. For future practice, women should be given a choice of gender were practical, however it does not appear to have any effect on discomfort or satisfaction.
FC3.22.08 RANDOMIZED PLACEBO CONTROLLED TRIAL TO ASSESS THE ROLE OF LIDOCAINE AEROSOL SPRAY IN OUTPATIENT HYSTEROSCOPY D. Soriano S. Ajaj, T. Chuong, B. Deval, A. Fauconnier. E Darai, -> Service de GynCcologie, HBpital HBtel-Dieu, Paris. France. Objective: We conducted a randomized, placebo-controlled trial to assess the efficacy of lidocaine spray during outpatient hysteroscopy in reducing the procedure pain and to identify risk factors for this discomfort. Study Methods: One hundred twenty one patients undergoing outpatient hysteroscopy were randomly assigned to have application of lidocaine spray or placebo to the uterine cervix, during outpatient hysteroscopy. Main Outcome Measures was the evaluation of pain during hysteroscopy on a visual analogue scale. Results: There was no statistically significant difference between the study and the control groups in the mean f SD age of the patients, the rate of nulliparity, postmenopausal state, the need for cervical dilation, or in the percentage of women using hormone replacement therapy. The indications for diagnostic hysteroscopy were similar in the two groups. Women in the anesthetic group had statistically significant less pain during the procedure in comparison with women in the placebo group 2.2 f 1.9 and 3.7 f 2.5 respectively (p
FC3.22.05 NATIONAL SURVEY OF OUT-PATIENT HYSTEROSCOPY IN THE UK L. Ronerson, S. Duffy, Dept. OBIGYN, St. James’s University Hospital, Leeds, UK. Objectives: The investigation of women with bleeding using outpatient hysteroscopy has been established in a number of units in the UK. The benefit to patients and the Health Service is currently under review. The extent to which outpatient hysteroscopy is available to patients is not clear, possibly due to preferred alternative clinical practice. In 1994. 1995 over 100,000 diagnostic procedures were undertaken for menorrhagia in England alone, with only 30,000 of these performed in the out-patient setting. This survey is designed to explore the current practice in relation to outpatient hysteroscopy with staffing levels, training facilities and equipment used with the underlying reasons as to why it may not be in use. Study Methods: We sent postal questionnaires to all consultant gynecologists in the UK with no reminder sent for non-responders. Results: Of 1148 questionnaires sent 629 were returned (55%) response rate, a previous study in 1996 initiated at Bradford in the UK had a response rate of 43%. The findings relating to the differing practices will be presented in detail but 48% of respondents had an interest in minimal access surgery. 54% had out-patient hysteroscopy available to them and of the ones with no facility 76% would like it instituted. Conclusions: Out-patient hysteroscopy is widely available and in the units where it is not, there is a significant desire for the facility to be initiated. There is a huge variation in equipment, facilities and staffing for out-patient hysteroscopy.
FC3.22.06 FLEXIBLE OUTPATIENT HYSTEROSCOPY AT A DISTRICT GENERAL HOSPITAL: PATIENT’S PAIN RELIEF AND SATISFACTION WITH A COMBINATION OF ORAL AND LOCAL ANALGESIA. A C Paul, Bangladesh Medical College, Dhaka, Bangladesh. M A Debono, Dept. OBIGYN, Halifax General Hospital, Salterhebble, Halifax, U.K. Objectives: To study the effect of oral diclofenac and lignocaine spray to the cervix on level of patients pain relief and satisfaction during outpatient flexible hysteroscopy. Study Methods: From July 1998 to October 1999, patients having outpatient flexible hysteroscopy were invited to participate into this prospective study and 160 of them agreed. For analgesia, they had oral diclofenac and local lignocaine spray. Hysteroscopy was performed with a 3mm flexible hysteroscope. The data was collected from a standardized data collection form filled by the patients immediately after and at 15 minutes of the procedure. A visual analogue chart was used to document pain as mild, moderate and severe. To assess their satisfaction, patients were asked whether they would consider this procedure in future. Results: The most common indication for hysteroscopy was abnormal vaginal bleeding. There were 51(31%) postmenopausal and 59(36%) perimenopausal women with abnormal vaginal bleeding. During the procedure, 44 (27%) women had no pain and in 63(39%) the pain was mild. Moderate pain was complained by 46(29%) and in 7 (4%) the pain was severe. Hysteroscopy was completed in 157(98%) and 155(96%) had endometrial biopsy. At 15 minutes after hysteroscopy, 90(56%) complained of no pain. Mild, moderate and severe pain was reported by 47(30%), 18(11.25%) and 5 (3%) of the women respectively. If required for them, 156(97.5%) of the women will consider this procedure in future. Conclusions: Outpatient hysteroscopy with oral diclofenac and lignocaine spray to the uterine cervix is a well tolerated procedure and highly appreciated by the patients.
WEDNESDAY,
SEPTEMBER
6
FC3.22.07 DOES THE “Y” IN OUT-PATIENT HYSTEROSCOPY MATTER? P. P. MC Gurgan, P O’Donovan, MERIT Centre, Bradford Royal Infirmary, U.K. Objectives: Evaluate the preconceptions and perceptions of patients having out-patient hysteroscopy, with emphasis on their attitudes towards the gynaecologist’s gender. Study methods: Prospective anonymous questionnaire used before and after the procedure for women referred to an out-patient hysteroscopy clinic in a district general hospital, where the surgeon was randomly allocated, and blinded to results. Results: Out patient hysteroscopy was performed on 77 patients, (38 and 39 patients had a male or female surgeon respectively). The two groups of patients were similar in age, parity, ethnicity, referral source and pre-medication use. Fifteen (39%) of the patients allocated to a male, and 9 (23%), of the patients allocated to a female would prefer a female hysteroscopist. This was not statistically significant (p= 0.12), no patients expressed a preference for a male. Gender preference had no significant effect on pre-operative anxiety (p=O.58), or procedure discomfort (p=O.76), or satisfaction (p=O.28). Patients treated by a male were more likely to state that the procedure would have been improved by having a female surgeon (p=O.O54). Conclusions: The preference rates for gender are comparable to other published studies. Patients treated by operators of different genders do not have any difference in discomfort or satisfaction scores, but women treated by men perceive that the procedure would be improved if they were treated by a female operator. For future practice, women should be given a choice of gender were practical, however it does not appear to have any effect on discomfort or satisfaction.
FC3.22.08 RANDOMIZED PLACEBO CONTROLLED TRIAL TO ASSESS THE ROLE OF LIDOCAINE AEROSOL SPRAY IN OUTPATIENT HYSTEROSCOPY D. Soriano S. Ajaj, T. Chuong, B. Deval, A. Fauconnier. E Darai, -> Service de GynCcologie, HBpital HBtel-Dieu, Paris. France. Objective: We conducted a randomized, placebo-controlled trial to assess the efficacy of lidocaine spray during outpatient hysteroscopy in reducing the procedure pain and to identify risk factors for this discomfort. Study Methods: One hundred twenty one patients undergoing outpatient hysteroscopy were randomly assigned to have application of lidocaine spray or placebo to the uterine cervix, during outpatient hysteroscopy. Main Outcome Measures was the evaluation of pain during hysteroscopy on a visual analogue scale. Results: There was no statistically significant difference between the study and the control groups in the mean f SD age of the patients, the rate of nulliparity, postmenopausal state, the need for cervical dilation, or in the percentage of women using hormone replacement therapy. The indications for diagnostic hysteroscopy were similar in the two groups. Women in the anesthetic group had statistically significant less pain during the procedure in comparison with women in the placebo group 2.2 f 1.9 and 3.7 f 2.5 respectively (p