Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study

Objective: This study aimed to compare efficacy and safety of lidocaine versus tramadol versus placebo in reducing the pain of diagnostic outpatient hysteroscopy (OH) in postmenopausal women.Materials and methods: This randomized double-blinded study included 156 menopausal women who received intrauterine lidocaine infusion or oral tramadol (50 mg) or placebo before diagnostic OH (52 women/group). Primary outcome was pain severity during the procedure using a 10-cm visual analog scale. Secondary outcomes were pain scores 10 and 30 min post procedure, satisfaction level, and ease of cervical entry.Results: Lidocaine had lower pain scores compared to placebo during and 10 min after the procedure (p < 0.001). Tramadol had lower pain scores than placebo during the procedure (p = 0.04), 10 min after the procedure (p = 0.03), and 30 min after the procedure (p = 0.04). Both lidocaine and tramadol resulted in an easier procedure than placebo (p < 0.001 and p = 0.04, respectively). Lidocaine had an easier cervical entry compared to tramadol (p = 0.004). Satisfaction scores in the lidocaine and tramadol groups were significantly higher than in the placebo group (p < 0.001).Conclusions: Lidocaine and tramadol were effective in reducing postmenopausal women-reported pain during and after diagnostic OH. However, lidocaine was better than tramadol in facilitating hysteroscope passage through the cervical canal and the reduction in pain levels with lidocaine was clinically relevant.Trial registration number: NCT03701984.

The effects of exercise induced tachycardia on the maternal electrocardiogram

OBJECTIVE

To determine whether pregnancy has an effect on the maternal electrocardiographic response to stress.

DESIGN

Eight maternal ECG parameters were screened before, during and after exercise induced tachycardia at 29 and 37 weeks gestation and at 6 weeks post partum for each participant.

SETTING

General Hospital in Safed, Israel.

SUBJECTS

Fifteen healthy, pregnant women aged 22 to 34 years with singleton pregnancies volunteered from the peripheral antenatal clinics.

INTERVENTION

Exercise stress tests were performed on a Quinton 3000 treadmill stress test system according to a Modified Bruce Protocol, producing a heart rate of 85% of age predicted maximum.

MAIN OUTCOME MEASURES

The ST-segment, T-wave, QRS complex, axis, rhythm, disorders of impulse conduction, the P-Q and Q-T intervals were screened before, during and after the exercise test.

RESULTS

The study results suggest an increase in the ST-segment changes induced by stress at 37 weeks of pregnancy compared to 29 weeks (ST-depression in 6 women out of 15 versus 2, P = 0.125, McNemar's Test for Correlated Proportions-Exact Test, two tailed; 95% CI, 0.042-0.492, 0.01 < P < 0.05) and to the post partum test (ST-depression in 6 women out of 15 versus 1, P = 0.125; 0.029-0.637, 0.01 < P < 0.05). No significant alteration of the other ECG parameters. No significant correlation between blood haemoglobin level, serum levels of sodium, potassium, calcium, glucose and 17 beta-oestradiol with the appearance of the ECG change.

CONCLUSIONS

The increase in the exercise induced ST-segment abnormalities at 37 weeks of pregnancy may be another physiological effect of late pregnancy which has not been demonstrated previously.

Case of late pulmonary embolectomy

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