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Ouerdane Y, Elmegeed AA, Tarek M, Bakhtaoui I, Awad AK, Al Riyami N, Saad A. Is Forced Coughing Effective in Reducing Pain During Cervical Biopsy?: A systematic review and meta-analysis. Sultan Qaboos Univ Med J 2023; 23:433-439. [PMID: 38090243 PMCID: PMC10712392 DOI: 10.18295/squmj.5.2023.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/01/2023] [Accepted: 05/03/2023] [Indexed: 12/18/2023] Open
Abstract
This review aimed to compare the potential analgesic effect of forced coughing (FC) with that of local anaesthetics (LA) or placebo during cervical biopsy. A total of 5 electronic databases-Scopus, PubMed, Web of Science, Cochrane Library and Google Scholar-were systematically searched from inception till March 2021. Data were extracted from 6 randomised controlled trials and analysed. During cervical biopsy, the overall effect favoured LA over FC (mean difference [MD] = 1.06, 95% confidence interval [CI]: 0.58 to 1.54; P <0.0001). Compared to no pain management, pooled data were comparable between the two groups (MD = -1.2, 95% CI: -3.35 to 0.94; P = 0.27). Procedure duration was significantly longer in the LA group than in the FC group (MD = -1.94, 95% CI: -2.47 to -1.41; P <0.00001). FC and LA are both useful pain-lowering modalities during cervical biopsy, depending on the setting and their availability.
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Affiliation(s)
| | | | - Mohammed Tarek
- Department of Medicine, Al-Azhar University, Cairo, Egypt
| | - Imane Bakhtaoui
- Department of Pediatric Surgery, Saad Dahlab University, Blida, Algeria
| | - Ahmed K. Awad
- Department of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nihal Al Riyami
- Department of Obstetrics and Gynecology, Sultan Qaboos University, Muscat, Oman
| | - Ahmed Saad
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
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2
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Pouli D, Thieu HT, Genega EM, Baecher-Lind L, House M, Bond B, Roncari DM, Evans ML, Rius-Diaz F, Munger K, Georgakoudi I. Label-free, High-Resolution Optical Metabolic Imaging of Human Cervical Precancers Reveals Potential for Intraepithelial Neoplasia Diagnosis. CELL REPORTS MEDICINE 2020; 1. [PMID: 32577625 PMCID: PMC7311071 DOI: 10.1016/j.xcrm.2020.100017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While metabolic changes are considered a cancer hallmark, their assessment has not been incorporated in the detection of early or precancers, when treatment is most effective. Here, we demonstrate that metabolic changes are detected in freshly excised human cervical precancerous tissues using label-free, non-destructive imaging of the entire epithelium. The images rely on two-photon excited fluorescence from two metabolic co-enzymes, NAD(P)H and FAD, and have micron-level resolution, enabling sensitive assessments of the redox ratio and mitochondrial fragmentation, which yield metrics of metabolic function and heterogeneity. Simultaneous characterization of morphological features, such as the depth-dependent variation of the nuclear:cytoplasmic ratio, is demonstrated. Multi-parametric analysis combining several metabolic metrics with morphological ones enhances significantly the diagnostic accuracy of identifying high-grade squamous intraepithelial lesions. Our results motivate the translation of such functional metabolic imaging to in vivo studies, which may enable improved identification of cervical lesions, and other precancers, at the bedside.
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Affiliation(s)
- Dimitra Pouli
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA.,Present address: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Hong-Thao Thieu
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Elizabeth M Genega
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michael House
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Brian Bond
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.,Present address: Department of Obstetrics and Gynecology, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Danielle M Roncari
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Megan L Evans
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Francisca Rius-Diaz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Málaga, 32 Louis Pasteur Boulevard, 29071 Málaga, Spain
| | - Karl Munger
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA.,Lead Contact
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3
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Wetcho T, Rattanaburi A, Kanjanapradit K. Quality of tissue from punch biopsy forceps vs. round loop electrode in colposcopically directed biopsy: a randomized controlled trial. J Gynecol Oncol 2018; 29:e52. [PMID: 29770623 PMCID: PMC5981104 DOI: 10.3802/jgo.2018.29.e52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/01/2017] [Accepted: 03/03/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the quality of tissue from punch biopsy forceps (PB group) with round loop electrode (LE group) in colposcopically directed biopsy along with the evaluation of pain associated with each procedure. Methods Patients with abnormal cervical cytologic results and abnormal colposcopic findings were enrolled into a randomized trial into either a PB group or LE group. The quality of tissue was evaluated in regards to the size of tissue, site of tissue, and tissue damage. Each quality had 1 to 3 points and the sum of each quality contributed to the total tissue score that ranged from 3 to 9. Pain associated with each procedure was assessed by a visual analog scale (VAS). This was a clinical trial study and was registered at www.clinicaltrials.in.th (Identifier: TCTR20160404001). Results Ninety-six women who met all eligibility requirements were enrolled in the study. Forty-eight patients were randomly assigned to the PB group and 48 patients were randomized into the LE group. The characteristics of the patients were similar between the 2 groups with the exception of the median age. The median total tissue score was 8 points in the LE group which was more than the median of 7 points in the PB group with a statistically significant difference (p=0.014). However, the median VAS pain score in both groups was 3.4 (p=0.82). Conclusion The quality of cervical tissues obtained from biopsy with a round loop electrode was better than the punch biopsy forceps with no difference in the level of pain.
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Affiliation(s)
- Thanita Wetcho
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Athithan Rattanaburi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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4
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Bednarek PH, Creinin MD, Reeves MF, Cwiak C, Espey E, Jensen JT. Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. Contraception 2014; 91:193-7. [PMID: 25487172 DOI: 10.1016/j.contraception.2014.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if ibuprofen 800mg reduces pain with intrauterine device (IUD) insertion among U.S. women. STUDY DESIGN We conducted a randomized, double-blind, placebo-controlled trial of women undergoing IUD insertion approximately 2-6weeks following first-trimester uterine aspiration. Subjects were randomized to receive ibuprofen 800mg or placebo 30-45min prior to IUD insertion. A 100-mm visual analog scale (VAS) was administered to measure pain after speculum insertion (baseline) and immediately following IUD insertion. RESULTS A total of 202 women were enrolled, with 101 randomized to each group (ibuprofen or placebo). Sociodemographic characteristics and baseline VAS scores were similar between groups. The median pain score with IUD insertion was 41.5mm in the placebo group and 38.0mm in the ibuprofen group (p=.50). Mean and median pain scores did not differ between placebo and ibuprofen when nulliparous and parous women were analyzed independently. Overall, median pain scores were 17.5mm higher in nulliparous women than parous women (p=.004). Median pain scores did not differ by age, IUD-type, history of dysmenorrhea or time since aspiration. CONCLUSIONS Administration of ibuprofen 800mg prior to IUD insertion does not reduce pain associated with the procedure for U.S. women. Overall, nulliparous women report more pain with IUD insertion than multiparous women.
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Affiliation(s)
- Paula H Bednarek
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | | | - Carrie Cwiak
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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5
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Bogani G, Serati M, Cromi A, Di Naro E, Casarin J, Pinelli C, Rossi T, Ghezzi F. Local anesthetic versus forced coughing at colposcopic-guided biopsy: a prospective study. Eur J Obstet Gynecol Reprod Biol 2014; 181:15-9. [PMID: 25124705 DOI: 10.1016/j.ejogrb.2014.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/07/2014] [Accepted: 07/20/2014] [Indexed: 11/28/2022]
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6
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Pierce JG, Bright S. Performance of a colposcopic examination, a loop electrosurgical procedure, and cryotherapy of the cervix. Obstet Gynecol Clin North Am 2014; 40:731-57. [PMID: 24286998 DOI: 10.1016/j.ogc.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Colposcopy is the accepted diagnostic test for evaluation of an abnormal Pap test to determine the location and extent of cervical intraepithelial lesions (CIN). Loop electrocautery excision procedure (LEEP) is the preferred procedure for advanced diagnosis and treatment of CIN following colposcopy. Although LEEP is the preferred treatment of CIN, cryotherapy is an option for treatment in some settings due to it's ease of performance, minimal complications, and cost-effectiveness. This article focuses on the proper technique and use of these procedures to evaluate and treat cervical abnormalities.
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Affiliation(s)
- John G Pierce
- Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System, 1250 East Marshall Street, PO Box 980034, Richmond, VA 23298-0034, USA.
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8
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Tangsiriwatthana T, Duangkum C, Suwunnapang S, Sripipattanakul M. Cervical Spray Versus Intracervical Injection in Loop Electrosurgical Excision Procedure: A Randomized Controlled Trial. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Chatuporn Duangkum
- Department of Obstetrics and Gynecology, Khon Kaen Hospital, Muang, Khon Kaen, Thailand
| | - Sekson Suwunnapang
- Department of Obstetrics and Gynecology, Khon Kaen Hospital, Muang, Khon Kaen, Thailand
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The utility of endocervical curettage: does routine ECC at the time of colposcopy for low-grade cytologic abnormalities improve diagnosis of high-grade disease? Am J Obstet Gynecol 2012; 206:530.e1-3. [PMID: 22541611 DOI: 10.1016/j.ajog.2012.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/29/2012] [Accepted: 03/26/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the use of endocervical curettage at the time of colposcopy for low-grade cytologic abnormalities. STUDY DESIGN We conducted a retrospective chart review of women with low-grade Papanicolaou smears who had undergone satisfactory colposcopic examinations with identifiable lesions. We evaluated results during a 2-year period thereafter to determine whether endocervical curettage increased the diagnosis of high-grade dysplasia. RESULTS The study group consisted of 374 patients. Of these patients, 16 had endocervical curettages suggestive of high-grade dysplasia. Of these 16 patients, 4 did not have concomitant high-grade dysplasia identified on ectocervical biopsy. Therefore, 93 to 94 endocervical curettages needed to be performed to detect 1 case of high-grade dysplasia that would not have been identified otherwise. CONCLUSION Routine endocervical curettage at the time of satisfactory colposcopy for low-grade cytologic abnormalities with a visible lesion does not significantly improve the diagnosis of high-grade dysplasia.
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10
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Colposcopy to evaluate abnormal cervical cytology in 2008. Am J Obstet Gynecol 2009; 200:472-80. [PMID: 19375565 DOI: 10.1016/j.ajog.2008.12.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/05/2008] [Accepted: 12/22/2008] [Indexed: 12/19/2022]
Abstract
The rates of cervical cancer in the United States are low in comparison with developing nations. Whereas the Papanicolaou smear has performed well in terms of detecting both precursors of squamous cell carcinoma and squamous cell carcinoma of the cervix, this test has been less successful at identifying those women with the highest-risk premalignant disease. The use of human papillomavirus testing has also contributed to the improved sensitivity of screening for cervical cancer. In light of this, the colposcopy clinic retains high referral rates yet has poor diagnostic accuracy. Unfortunately, patients are triaged to follow-up for abnormal Papanicolaou smears based on algorithms that rely on the less evidence-based techniques of colposcopy. Therefore, the need to improve the specificity of colposcopic-guided biopsy remains. The colposcopic procedure is highlighted in this review and evaluated in terms of current literature on technique, the colposcopic impression, cervical biopsy, and methods proposed to enhance appreciation of the highest-risk lesions. By outlining certain flaws in technique and discussing the proposal of new tests to supplement the current standard of care, this review aimed to highlight the need for future research to maintain sensitivity but improve the specificity of colposcopy.
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11
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Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial. Am J Obstet Gynecol 2008; 199:641.e1-3. [PMID: 18822403 DOI: 10.1016/j.ajog.2008.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 04/24/2008] [Accepted: 07/07/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cervical biopsy often causes discomfort and pain. To compare local anesthesia (1% lidocaine) with forced coughing as pain relief, we quantified the actual pain experienced during cervical punch biopsies. STUDY DESIGN For a prospective trial conducted at the Medical University of Vienna, 68 women undergoing cervical punch biopsies for assessment of abnormal cervical smears were randomized in 2 pain relief treatment groups. Patients' discomfort was assessed immediately after taking the biopsy using at 10-cm visual analog scale. RESULTS No statistically significant difference was found between pain scores recorded for the 2 groups (P = .47, 95% confidence interval [CI], -0.4 to 1.3 cm). However, when local anesthesia was applied, the examination was significantly prolonged by a median of 2.11 min (P < .001; 95% CI, 1.6-2.8). CONCLUSION Forced coughing during cervical biopsies reduces patients' discomfort to the same extent as local anesthesia, but is associated with a significantly reduced examination time.
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12
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Hubacher D, Reyes V, Lillo S, Zepeda A, Chen PL, Croxatto H. Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen. Am J Obstet Gynecol 2006; 195:1272-7. [PMID: 17074548 DOI: 10.1016/j.ajog.2006.08.022] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 07/07/2006] [Accepted: 08/31/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study was undertaken to determine whether 400 mg of prophylactic ibuprofen can alleviate pain from insertion of an intrauterine device (IUD) and to measure level of pain with improved techniques. STUDY DESIGN We conducted a randomized, double-blind, placebo-controlled trial of 2019 first-time IUD users: 1008 women received placebo and 1011 women received 400 mg of ibuprofen. Participants took the single tablet at least 45 minutes before IUD insertion. Immediately after insertion, participants recorded level of pain by using a 10-cm visual analog scale, with the value of 10 meaning "worst imaginable pain." RESULTS Median level of pain was 1.0 for both ibuprofen and placebo participants; rank test statistics confirmed no difference. Some subgroups of women experienced higher pain (eg, nulliparous women), but ibuprofen still had no important impact on level of pain. CONCLUSION Even among first-time users, pain from IUD insertion is generally low. Prophylactic ibuprofen as used in this protocol does not reduce IUD insertion pain.
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Affiliation(s)
- David Hubacher
- Family Health International, Research Triangle Park, NC, USA
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13
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Cruickshank ME, Anthony GB, Fitzmaurice A, McConnell D, Graham W, Alexander DA, Tunstall M, Ross JAS. A randomised controlled trial to evaluate the effect of self-administered analgesia on women's experience of outpatient treatment at colposcopy. BJOG 2005; 112:1652-8. [PMID: 16305570 DOI: 10.1111/j.1471-0528.2005.00782.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of self-administered isoflurane and desflurane on women's experience of outpatient treatment at colposcopy. DESIGN A prospective double-blinded randomised controlled trial. SETTING A colposcopy clinic serving a regional population. POPULATION Three hundred and ninety-six women scheduled for treatment of cervical intraepithelial neoplasia (CIN) by large loop excision of the transformation zone (LLETZ). METHODS Self-administration of trial gas during a LLETZ procedure. One hundred and ninety-eight women were randomised to use isoflurane and desflurane and 198 to use placebo. MAIN OUTCOME MEASURES Patient satisfaction, pain and anxiety. RESULTS The mean pain score for cervical surgery was significantly lower for women using isoflurane and desflurane (22.4) than the placebo arm (29.6) (P= 0.003). There was no significant difference between arms in anxiety levels before or after treatment. More women using isoflurane and desflurane (78%) reported 'total helpfulness' of the trial gas than those using placebo (67%) (P= 0.012). A subgroup analysis of trial participants classified as anxious by Hospital Anxiety and Depression Scale (HADS) score at recruitment showed that using isoflurane and desflurane significantly increased total treatment acceptability, helpfulness of the gas and willingness to undergo a similar procedure at six-month follow up. CONCLUSION Satisfaction with outpatient treatment at colposcopy is generally high. The main effect of isoflurane and desflurane evaluated in this trial was to reduce pain. It appeared to be effective for women with clinically significant anxiety and could be offered as an alternative to general anaesthesia.
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Affiliation(s)
- M E Cruickshank
- Wellbeing Centre for the Prevention of Cervical Cancer, University of Aberdeen, UK
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14
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Basen-Engquist K, Shinn EH, Warneke C, de Moor C, Le T, Richards-Kortum R, Follen M. Patient distress and satisfaction with optical spectroscopy in cervical dysplasia detection. Am J Obstet Gynecol 2003; 189:1136-42. [PMID: 14586367 DOI: 10.1067/s0002-9378(03)00540-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this investigation was to evaluate the impact of optical spectroscopy, a new approach for the detection of cervical dysplasia, on patient well-being and satisfaction. STUDY DESIGN Patient distress and satisfaction with optical spectroscopy compared with the Papanicolaou test and colposcopically directed biopsy were measured in a volunteer sample of 314 women with no history of abnormal Papanicolaou test findings. RESULTS Participants reported significantly less pain and anxiety (P<.001) during optical spectroscopy than during the Papanicolaou test or colposcopically directed biopsy. Generally, participants found spectroscopy equal to the Papanicolaou test and to biopsy on a variety of questions that measured satisfaction. There were statistically significant differences between spectroscopy and the Papanicolaou test or biopsy on issues such as the discomfort and fear caused by the test, the amount of time taken, the room lighting, and perceptions of accuracy. CONCLUSION That patients reported less distress during spectroscopy than during a Papanicolaou test, colposcopy, or biopsy suggests the possibility of improved adherence to cervical cancer screening and follow-up in settings in which it is used.
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Affiliation(s)
- Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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15
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Oyama IA, Wakabayashi MT, Frattarelli LC, Kessel B. Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial. Am J Obstet Gynecol 2003; 188:1164-5. [PMID: 12748465 DOI: 10.1067/mob.2003.290] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether administration of local anesthetic reduces pain associated with colposcopically directed cervical biopsies. STUDY DESIGN Fifty-six patients undergoing colposcopically directed cervical biopsies were randomly selected prospectively to receive a 1% lidocaine injection or no injection before the biopsy procedure. Pain was assessed by using a 10-cm visual analog scale at various points during the procedure. Data were analyzed with the Student t test. RESULTS Injection of lidocaine resulted in a reduction in pain scores for cervical biopsies (4.004 to 1.166, P: <.001), endocervical curettage (5.757 to 3.900, P =.0018), and overall procedure scores (4.911 to 3.145, P =.0013). CONCLUSION This pilot study demonstrates that injection of local anesthetic at the site of colposcopically direct cervical biopsies decreases the pain perceived by patients.
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Affiliation(s)
- Ian A Oyama
- Department of Obstetrics and Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, HI, USA
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16
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Abstract
This article reviews the published literature for topical anesthetics that have been used for pain relief during minor gynecological procedures. EMLA (an eutectic mixture of the local anesthetics, lidocaine 2.5% and prilocaine 2.5%), which is the best-studied topical anesthetic, produces effective analgesia for superficial surgical procedures after application for 5 to 10 minutes and has been extensively studied in various procedures including removal of genital warts, vulval biopsy, laser treatment of CIN lesions, and hysteroscopy. EMLA is well tolerated and provides good pain relief for procedures involving the surface tissues such as removal of genital warts and hysteroscopy. For procedures involving deeper tissues, EMLA reduces the pain of local anesthetic injection. Other topical anesthetics, such as lidocaine gel and spray, benzocaine 20% gel, mepivacaine solution, tetracaine solution, and cocaine spray, have been less extensively studied in these indications, and benefits seem to be limited.
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Affiliation(s)
- Arthur Zilbert
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada.
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