Assessment of Pain at Different Steps of Diagnostic Hysteroscopy Using Room Temperature Normal Saline versus Warmed Normal Saline Solution as Distension Medium

Objectives:
Compare pain intensity at entry into the cervical os, during uterine distension and 15 min after the procedure, in patients undergoing diagnostic hysteroscopy with room temperature normal saline versus that with saline warmed to 38–40°C, using visual analog scale (VAS) score. Furthermore, compare the time taken and failed procedures between them.


Materials and Methods:
This was a randomized controlled, prospective study conducted at a Tertiary Care Center on 100 patients planned for diagnostic hysteroscopy with a 4 mm 30° hysteroscope using vaginoscopy technique. They were divided into two groups of 50 each, with control undergoing the procedure using normal saline at room temperature and the test with saline warmed to 38–40°C as distension medium. Primary outcomes were VAS at the point of entry into the internal os (T0), 1 min later (T1), and 15 min after the procedure (T15). Secondary outcomes were procedural acceptance, time taken, and failed procedures.


Results:
The mean VAS in the control group at T0, T1, T15 was 3.31 (1.461;[FIGURE DASH]0.870–0.245), 2.46 (1.398;[FIGURE DASH]0.539–0.498), 0.75 (0.911;[FIGURE DASH]0.379–0.338), respectively, as compared to the test group of 3.62 (1.282;[FIGURE DASH]0.870–0.245), 2.48 (1.148;[FIGURE DASH]0.540–0.498), 0.77 (0.911;[FIGURE DASH]0.379–0.379), respectively. About 73.5% of controls and 68.8% in the test group were willing to undergo the procedure again. About 93.9% of controls would recommend it further as against 93.8% among the test controls. The time taken and number of failed procedures showed no statistical difference.


Conclusion:
No significant difference was noted in terms of outcomes measured by warming the distension medium.