Cervical Priming with Hydroscopic Dilatator Before Hysteroscopy: Effect on Pain Scores and Ease of the Procedure

Abstract

OBJECTIVE: Aquacryl hydrogel is one of the cervical dilatators which is a synthetic rigid hydroscopic gel rod, indicated to be used for cervical preparation. The authors aimed to determine whether preoperative cervical preparation with Aquacryl hydrogel before hysteroscopy has any favorable effects either for the patient (pain scores) or for the surgeon (ease of the procedure).
STUDY DESIGN: The randomized controlled trial was undertaken in the Obstetrics and Gynecology Department of a University setting. Forty-three reproductive age women scheduled for hysteroscopy due to gynecological indications were randomized to receive hydroscopic dilatators for cervical preparation (n=19) or no intervention before the procedure (n=27). Visual analog scale (VAS) was used to evaluate pain scores until the operation. Analgesic administration was done in case of a VAS score ≥40 or patients’ demand for analgesia.Intraoperatively, mean arterial pressure and pulse were documented in order to evaluate analgesic requirement.
RESULTS: Median VAS scores at hydroscopic dilatator administration 0th, 1st, 2nd, 3rd, and 4th hours after insertion were 29±24 (0 - 80), 14±15 (0 - 6), 13±15 (0 - 5), 8±9 (0 - 30) and 5±9 (0 -3), respectively; where pain score significantly decreased in time (p<0.05). There was no significant difference between mean arterial pressure and heart rate values between groups throughout the preoperative and intraoperative follow up (p>0.05).
CONCLUSION: This study revealed that, Aquacryl hydrogel for cervical priming before office hysteroscopy is not effective to reduce the pain of patients’ during the procedure but also does not ease access to the uterine cavity. Therefore, it is not advantageous for the patient to use this agent before hysteroscopy.