LAUSR

OBJECTIVE To identify the optimal distension medium type, pressure and temperature to minimize pain during office hysteroscopy. DATA SOURCES MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception until 29th January 2020. METHODS OF STUDY SELECTION We included randomized controlled trials where women undergoing office hysteroscopy were randomized to either a distension medium type, pressure or temperature against a suitable control, where pain was an outcome. Data were also collected regarding feasibility, visualisation, complications and satisfaction. TABULATION, INTEGRATION AND RESULTS The literature search returned 847 studies, of which 18 were included for systematic review, and 17 for meta-analysis. There was no significant difference in intraprocedural pain when comparing the use of normal saline against carbon dioxide (SMD -0.12, 95% CI -0.36 to 0.13). Subgroup analysis of high-quality studies showed a statistically significant reduction in postprocedural pain with normal saline (SMD -0.65, 95% CI -1.14 to -0.16). Side-effects were less frequent (Peto OR 0.29, 95% CI 0.20-0.40) and patient satisfaction was higher (SMD 1.39, 95% CI 0.51-2.28) with normal saline compared to carbon dioxide. Pressures of ≤40mmHg reduced intraprocedural pain (SMD -0.67, 95% CI -1.09 to -0.26) at the expense of a higher proportion of unsatisfactory views (81-89% at ≤40mmHg vs 95-99% at ≥50mmHg). Postprocedural pain was reduced with lower filling pressures. Warming saline did not reduce intraprocedural pain (SMD 0.59, 95% CI -0.14 to 1.33). CONCLUSION Normal saline, instilled at the lowest pressure to acquire a satisfactory view should be used for uterine distension during office hysteroscopy to minimize pain.