Effectiveness of paracervical block for pain relief in women undergoing hysterosalpingography in Bayelsa State, South-South Nigeria: a randomized control trial
Background: One of the major short comings of hysterosalpingography is discomfort and/or pain for the patient during or after the investigative modality; and this is a major cause of anxiety for many patients. Objectives were to compare the effectiveness of paracervical block with 2% lignocaine and placebo in pain reduction when undergoing hysterosalpingography.
Methods: This randomised control trial was conducted at the radiology departments and infertility clinics of the Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, both in Bayelsa State, Nigeria, from July 2021-February 2022. Three hundred and eighty infertile women undergoing hysterosalpingography were assigned into two groups. Women in group I received paracervical block, while the women in group II received placebo. Data were analysed using statistical product and service solutions for windows® version 25. Results were presented in frequencies and percentages for categorical variables; mean and standard deviation for continuous variables. Student’s t-test was used to compare sample means; and Chi-square for associations.
Results: The mean pain score ± SD for group I was 3.8±2.6, while that in group II was 6.2±2.2. The difference between the means was statistically significant (t=9.77; p=0.001). While 140 (73.7%) women experienced moderate pain in group II, 70 (36.8%) women in Group I experienced moderate pain.
Conclusions: Our study revealed that paracervical block improved the overall pain score of women undergoing hysterosalpingography, although a significant proportion of the women expressed some pain during instillation of contrast media.
Anyanwu MO, Idoko P. Prevalence of Infertility at the Gambian Teaching Hospital. Women Health Gynecol. 2017;3(2):1-4.
Abdalla NM. Pattern of Infertility Among Couples in Gezira Area, Sudan. Med J Cairo Univ. 2011;79(2):529-32.
Panti AA, Sununu YT. The profile of infertility in a teaching Hospital in North West Nigeria. Sahel Med J. 2014;17(1):7.
Ugwuja EI, Ugwu NC, Ejikeme BN. Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria. Afr J Reprod Health. 2008;12(1):67-73.
Odunvbun WO, Oziga DV, Oyeye LO, Ojeogwu CL. Pattern of infertility among infertile couple in a secondary health facility in Delta State, South South Nigeria. Trop J Obstet Gynaecol. 2018;35(3):244.
Atalabi OM, Fayemiwo SA, Oladokun AA, Bakare RA. Pattern of asymptomatic sexually transmitted infections in women undergoing hysterosalpingography for infertility evaluation in Ibadan Nigeria. Trop J Obstet Gynaecol. 2013;30(2):91-8.
Oguntoyinbo AE, Adesina KT, Olarinoye AO, Aboyeji AP, Olanrewaju WI, Oniyangi M. Pre-HSG microbial isolates from endocervical swabs in infertile women in Ilorin, Nigeria. West Afr J Radiol. 2014;21(2):59-63.
Kiridi EK, Oriji PC, Abasi IJ. Effect of pre-procedure anxiety levels on post-procedure pain scores in women undergoing hysterosalpingography in South-South Nigeria. Int J Trop Dis Health. 2022;43.
Araoye MO. Subjects Selection. In: Research Methodology with statistics for Health and Social sciences. Ilorin. Nathadex publishers. 2003;115-29.
Menuba IE, Ugwu EO, Obi SN, Lawani LO, Onwuka CI. Clinical management and therapeutic outcome of infertile couples in southeast Nigeria. Ther Clin Risk Manag. 2014;10:763-8.
Yeung AWK, Wong NSM. The Historical Roots of Visual Analog Scale in Psychology as Revealed by Reference Publication Year Spectroscopy. Front Hum Neurosci. 2019;13.
Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37(4):378-81.
Chauhan MB, Lakra P, Jyotsna D, Nanda S, Malhotra V. Pain relief during hysterosalpingography: role of intracervical block. Arch Gynecol Obstet. 2013;287(1):155-9.
De Mello JFL, Abrao MS, Cerri GG, De Barros N. Evaluation of pain in three hysterosalpingography techniques: metal cannula with and without paracervical blockage and balloon catheter. AJR Am J Roentgenol. 2006;187(1):86-9.
Unlu BS, Yilmazer M, Koken G, Arioz DT, Unlu E, Dogan Baki E. Comparison of four different pain relief methods during hysterosalpingography: a randomized controlled study. Pain Res Manag. 2015;20(2):107-11.
Jain S, Inamdar DB, Majumdar A, Jain DK. Effectiveness of paracervical block for pain relief in women undergoing hysterosalpingography. J Hum Reprod Sci. 2016;9(4):230-5.
Robinson RD, Casablanca Y, Pagano KE, Arthur NA, Bates GW, Propst AM. Intracervical block and pain perception during the performance of a hysterosalpingogram: a randomized controlled trial. Obstet Gynecol. 2007;109(1):89-93.
Hacivelioglu S, Gencer M, Cakir Gungor A, Kosar S, Koc E, Cosar E. Can the addition of a paracervical block to systemic or local analgesics improve the pain perceived by the patient during hysterosalpingography? J Obstet Gynaecol J Inst Obstet Gynaecol. 2014;34(1):48-53.
Liberty G, Gal M, Halevy-Shalem T, Michaelson-Cohen R, Galoyan N, Hyman J, et al. Lidocaine-prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study. Hum Reprod Oxf Engl. 2007;22(5):1335–9.