Auricular acupuncture for postoperative pain after gynecological surgery: a randomized controlled trail.

BACKGROUND: Acupuncture for postoperative pain remains controversial. Potential sources of bias are failures in patient-blinding and therapist-patient interactions. Our study investigates the effects of electrical auricular acupuncture (AA) on postoperative pain in patients undergoing laparoscopy with an emphasis on patient-blinding and the exclusion of therapist-patient interactions. METHODS: With institutional review board approval and written informed consent, we included 40 female patients undergoing laparoscopy. Patients were randomly assigned to receive AA (shen men, thalamus and one segmental organ-specific point) or electrodes only and an electrical stimulation device. All patients received this intervention under general anesthesia guaranteeing patient blinding and excluding therapist-patient interactions. Needles and devices were removed 72 hours postoperatively. Postoperatively, patients received 1,000 mg paracetamol every 6 hours. Additional piritramide was given on demand. A blinded observer obtained the VAS scores at 0, 2, 24, 48, and 72 hours as well as the postoperatively administered doses of piritramide. RESULTS: There was no difference in VAS scores or the consumption of piritramide during the first 72 hours postoperatively between groups (acupuncture versus placebo: 2.32 [1.40-3.25] versus 2.62 [1.89-3.36] average pain on VAS 0-10; 15.3 [12.0-18.6] mg versus 13.9 [10.5-17.3] mg piritramide). Values are expressed as mean [CI]. CONCLUSION: Our study shows no reduction in postoperative pain or an opioid sparing effect of auricular acupuncture in women undergoing laparoscopic procedures. Because we emphasized blinding of the patients and the exclusion of therapist-patient interactions, our study suggests that electrical auricular acupuncture has no effect on postoperative pain.

[Ambulatory hysteroscopy in evaluation of postmenopausal bleeding]. / Die ambulante Hysteroskopie in der Abklärung der postmenopausalen Blutung.

INTRODUCTION: Diagnostic hysteroscopy is the most precise procedure to evaluate diseases involving the uterine cavity. There is, however, only limited data concerning the use of hysteroscopy carried out as an outpatient procedure in patients with postmenopausal bleeding. MATERIALS AND METHODS: In this study we report on 360 postmenopausal patients with erratic bleeding, who were referred to our outpatient hysteroscopy clinic. 185 women had frank postmenopausal bleeding (PMB) and another 175 had abnormal uterine bleeding while taking hormone replacement therapy (AUB). The mean age was 57.9 years (range: 42-86). All hysteroscopies were performed using a standard 5-mm hysteroscope with a 30 degrees fore-oblique lens; the uterine cavity was generally distended with normal saline. RESULTS: Outpatient hysteroscopy was performed successfully in 339 patients (94.2%). In 166 cases (46.1%) cervical dilatation was necessary, and 138 required (38.3%) intracervical anaesthesia. Intrauterine pathology was diagnosed in 49.6% of cases, with endometrial polyps (20.9%) and fibroids (15.9%) being the most common abnormalities. While there was no difference in the incidence of intrauterine lesions between patients with AUB and those with PMB, endometrial carcinoma was more common in the latter group (PMB: n = 11 vs. AUB: n = 1; p < 0.002). CONCLUSION: Due to its high accuracy and patient acceptance, outpatient diagnostic hysteroscopy should become a first line investigation in postmenopausal patients with bleeding disorders.

Atraumatic cervical passage at outpatient hysteroscopy.

OBJECTIVE: To evaluate the efficacy of topical anesthesia routinely administered to reduce discomfort and the need for additional local anesthesia during outpatient hysteroscopy. DESIGN: Comparative observational study. SETTING: Outpatient hysteroscopy clinic in a University hospital. PATIENT(S): Three hundred patients undergoing outpatient hysteroscopy. INTERVENTION(S): Application of lidocaine spray both to the surface of the cervix and into the cervical canal before performing hysteroscopy. MAIN OUTCOME MEASURE(S): The discomfort during passage of the hysteroscope through the cervical canal, the need for additional local anesthesia, and the failure rate of outpatient hysteroscopy. RESULT(S): One hundred fifty consecutive patients receiving lidocaine spray before the hysteroscopy were compared to a control group of another 150 consecutive patients who underwent the examination without pretreatment. Women treated with spray experienced significantly less pain at insertion of the hysteroscope. Furthermore, the spray significantly reduced both the need for additional anesthesia and the rate of failed hysteroscopies due to intolerable pain. CONCLUSION(S): Topical anesthesia with lidocaine spray is a simple method to alleviate patients' discomfort during cervical passage. It is effective in reducing the need for local anesthesia and should reduce the rate of failed outpatient hysteroscopies.