Oral
diclofenac potassium tab 30 minutes before hysterosalpingography (HSG) and
cervical lidocaine cream 5% significantly relieves pain and eases patient
anxiety during the procedure and for half an hour after reports the results of
a randomized trial published in September issue of journal Fertility and Sterility.
According to
American Society for Reproductive Medicine (ASRM) tubal factor infertility
accounts for 25%-30% of causes of female infertility, and HSG is simple and cost-effective
method for evaluation of tubal patency.
Often
patients are very apprehensive of the procedure because of pain felt during the
procedure. This small randomized trial investigated the effect of 50 mg of oral
diclofenac potassium half an hour before the procedure with lidocaine gel 5%
applied to the anterior cervical lip, followed by 3 ml placed in the cervical
canal using a sterile needless syringe vs placebo in alleviating the pain felt
with the procedure.
The trial
recruited 140 infertile women, comparable in demographic, parity and prior mode
of delivery and randomized to receive either diclofenac plus gel vs placebo.
The patients
self-evaluated the pain they felt during various steps of procedure like
placing the speculum, holding the anterior lip, injection of the dye and 5
minutes and 30 minutes after the procedure and rated it on a 10 cm Visual
Analog Scale(VAS).
A 2 cm
difference between pain rating between both the study arms was considered
clinically significant. The researchers also looked at any need of additional
analgesic and side effects of the test itself.
It was seen
that women in the diclofenac arm reported considerable less pain during pushing
of the dye, 5 minutes and 30 minutes post procedure (median: 4 vs. 7, p=0.0001;
2 vs. 4, p=0.0001; 1 vs. 2.5, p= 0.0001, respectively)
Nearly 50%
more women in the placebo group asked for additional analgesic (p=0.245).
The researchers
concluded that diclofenac potassium and cervical lidocaine is considerably
effective in reducing the pain during and after HSG test.
