Gaity Ahmad

Pain relief in office gynaecology: a systematic review and meta-analysis

Hysteroscopy, hysterosalpingography (HSG), sonohysterography and endometrial ablation are increasingly performed in an outpatient setting. The primary reason for failure to complete these procedures is pain. The objective of this review was to compare the effectiveness and safety of different types of pharmacological intervention for pain relief in office gynaecological procedures. A systematic search of medical databases including PubMed, EMBASE, Cochrane Central register of controlled trials, PsychInfo and CINHAL was conducted in 2009. Randomised controlled trials (RCTs) investigating the use of local anaesthetics, opioid analgesics, non-opioid analgesics and intravenous sedation for pain relief during and after hysteroscopy, HSG, sonohysterography and endometrial ablation were reviewed. Secondary outcomes included adverse effects and failure to complete procedures. Where RCTs were not identified, the best available evidence was sought. Each study was assessed against inclusion criterion. Results for each study were expressed as a standardised mean difference (SMD) with 95% confidence intervals and combined for meta-analysis with Revman 5 software. Meta-analysis revealed beneficial effect of the use of local anaesthetics during and within 30 min after hysteroscopy; SMD -0.45 (95% CI -0.73, -0.17) and SMD -0.51 (95% CI -0.81, -0.21) respectively. No beneficial effect was noted during HSG. One RCT found evidence of benefit for pain relief during hysterosalpingo-contrastsonography; SMD -1.04 [95% CI -1.44, -0.63]. There was no significant difference in failure to complete hysteroscopy due to cervical stenosis between the intervention and control groups (OR 1.31 (95% CI 0.66, 2.59)), but the incidence of failure to complete the procedure due to pain was significantly less in the intervention group (OR 0.29 (0.12, 0.69)). There is evidence of benefit for the use of local anaesthetics for outpatient hysteroscopy and hysterosalpingo-contrastsonography. Local anaesthetics may be considered when performing hysteroscopy in postmenopausal women to reduce the failure rate.

Laparoscopic entry techniques and complications

Objective: To identify laparoscopic entry techniques employed by gynecologists in the United Kingdom to determine if the consensus technique is adhered to, and to observe whether entry technique affects complication rate. Method: An anonymous postal questionnaire was sent to gynecologists with an interest in laparoscopic surgery in the United Kingdom. Results: At total of 568 questionnaires were sent and 345 (60.7%) were returned. Of gynecologists who returned the questionnaire 194 (57%) reported occurrence of a major bowel or vascular complication. In terms of the key elements of the consensus document there was no significant difference in entry technique used between those that reported major injury (vascular, bowel, or both), and those that did not. Conclusions: This survey demonstrates the variation in entry techniques used by gynecologists in the United Kingdom. Without a good evidence‐base to the contrary no entry technique can be stated as safer than another.

Pain relief in outpatient hysteroscopy: a survey of current UK clinical practice

BACKGROUND Outpatient hysteroscopy is increasingly being used as a cost-effective alternative to in-patient hysteroscopy under general anaesthesia. Like other outpatient gynaecological procedures, however, it has the potential to cause pain severe enough for the procedure to be abandoned. There are no national guidelines on pain relief for outpatient hysteroscopy. METHODS A postal survey of UK gynaecologists was carried out to evaluate current clinical practice regarding methods of pain relief used during office hysteroscopy. A total of 250 questionnaires were sent out and 115 responses received. RESULTS Outpatient hysteroscopy was offered by 76.5% of respondents. Respondents reported a wide variation in the use of routine and rescue analgesia, and also in the nature of the analgesia used. One-quarter of those offering outpatient hysteroscopy used no form of analgesia. CONCLUSION The results showed that whilst there is no consensus on the type of analgesia provided, rescue analgesia is commonly being used, particularly in the form of intracervical blocks.

Uterine-sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta-analysis

To evaluate the effectiveness of uterine‐sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus.

Pain relief during hysterosalpingography: A national survey

Hysterosalpingography is a part of the infertility workup and can be painful. We conducted a postal survey of Obstetric and Gynaecology departments in the UK to evaluate the current clinical practice regarding the methods used to provide pain relief during hysterosalpingography. A total of 166 questionnaires were sent and 104 responses were received. Hysterosalpingography was offered by 93.3% of respondents. Respondents reported a wide variation in clinical practice with regards to the timing and the nature of analgesia used. Interestingly, 38% of respondents did not use analgesia at all. This variation in clinical practice may reflect the sparsity of evidence contained within the literature.

Adhesions: Effects on Fertility and Prevention

Adhesions connect two or more points of organs or tissues that are normally separate and can be considered as the most common complication of abdominal and pelvic surgery. They have the potential to cause serious adverse effects such as small bowel obstruction, secondary infertility and can lead to increasingly complicated high risk operative procedures. Studies have illustrated the high burden placed on healthcare resources, with around a third of patients being readmitted for a related cause over 10 years, and upwards of an annual

Laparoscopic entry techniques

2 billion inpatient expenditure on related disease in the US.