RESUMEN
OBJECTIVE: To compare the effect of inhaled nitrous oxide (INO) on pain control during in-office hysteroscopy with 1% lidocaine paracervical infiltration and no analgesic. DESIGN: Single-blind stratified randomised clinical trial with masked assessment by a third party. SETTING: Department of Obstetrics and Gynaecology in a Spanish hospital. POPULATION: Women who underwent hysteroscopy. METHODS: Patients were stratified into three groups according to the purpose of the hysteroscopy (biopsy, polypectomy or tubal sterilisation) and then assigned to different treatment groups through a permuted-blocks randomisation within strata. Pain scale was provided by a gynaecologist totally blinded to procedures and treatments. Effects were assessed using a one-way analysis of variance following an intention-to-treat approach. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) from 0 to 100 mm. RESULTS: A total of 314 women were included: 105 to INO, 104 to 1% lidocaine and 105 to no analgesic. Baseline characteristics were comparable. Mean VAS score after the procedure was 34.7 ± 25.8 mm, 36.1 ± 22.9 mm (P = 1.0) and 47.3 ± 28.2 mm (P = 0.001) for INO, 1% lidocaine and no analgesic, respectively. No adverse events were reported in 91 (86.7%) patients in the INO group compared with 79 (76%) in the 1%-lidocaine group (P = 0.04) and 85 (81%) in the no-analgesic group (P = 0.26). CONCLUSION: INO was as effective as 1% lidocaine in pain control for in-office hysteroscopy and was better tolerated. The no-analgesic group presented the poorer results, so was the least recommended clinical option.
Asunto(s)
Atención Ambulatoria , Anestésicos por Inhalación/administración & dosificación , Anestésicos Locales/administración & dosificación , Histeroscopía , Lidocaína/administración & dosificación , Óxido Nitroso/administración & dosificación , Manejo del Dolor/métodos , Adulto , Anestésicos por Inhalación/efectos adversos , Anestésicos Locales/efectos adversos , Biopsia , Femenino , Humanos , Lidocaína/efectos adversos , Persona de Mediana Edad , Óxido Nitroso/efectos adversos , Pólipos/cirugía , Método Simple Ciego , Esterilización Tubaria , Neoplasias Uterinas/cirugíaRESUMEN
El cirujano endoscopista ginecológico debe estar familiarizado con los principios, aplicaciones y aspectos de seguridad de las fuentes de energía que se usan durante la cirugía. Al utilizar una fuente de energía eléctrica lo que físicamente hacemos es impulsar electrones con un voltaje dado concentrándolos en una localización específica del tejido para producir un efecto tisular deseado. Este podrá ser un efecto de corte o de coagulación. En la obtención de dicho efecto interviene el tipo de corriente , el tipo de tejido y el aplicador o terminal empleado. En este trabajo hacemos un repaso de los fundamentos de la energía eléctrica empleada en cirugía y los tipos de corrientes más frecuentemente usados, así como de sus diferentes aplicaciones clínicas
Gynaecologic endoscopist should thoroughly knows the basis, uses and security ítems related to electrosurgical energy. When using electric energy we shoot electrons to an specific tissue spot to induced a desired cutting or coagulating tissular effect. The desired tissular effect depend on the type of current, the type of tissue and the type of the instrument we use to apply the electric energy. We review the basis of electric energy, the different type of electric current and its use on surgical procedures