Effect of addition of antispasmodic to local and systemic analgesics on pain perception during hysterosalpingography: a randomized controlled trial

Enefia Kelvin Kiridi, Peter Chibuzor Oriji, Akaninyene Eseme Ubom, Johnpatrick Uchenna Ugwoegbu, Addah Abednigo Ojanerohan, Isaac Joel Abasi, Bosrotsi Panebi, Adesina Adedotun Daniel

Abstract

Background: Tubal factor is responsible for most of the causes of infertility, especially in our environment, and hysterosalpingography (HSG) is the investigation of choice for assessing tubal patency. Objective of current study was to evaluate the effect of the addition of intramuscular hyoscine-N-butyl bromide (HBB) to local and systemic analgesics on pain perception during hysterosalpingography.

Methods: This randomized controlled trial was conducted at the radiology departments and infertility clinics of four health institutions in Bayelsa State, Nigeria, from January 2020 to April 2022. One thousand and forty infertile women undergoing hysterosalpingography were randomized into four groups, and each group administered four different pain relief methods. Pain scores at different steps of the procedure were recorded. Data were analysed using the Statistical Product and Service Solutions for Windows®, version 25. Student’s t-test was used to compare sample means, while the chi-square test was used to compare the proportion of women in the two study groups, who expressed pain during the procedure.

Results: The Paracervical block+HBB appeared to the most effective agent for pain relief in the study as women receiving this medication indicated the least pain intensity scores at all levels of the procedure except at the insertion of the speculum. The differences observed in the indicated pain intensity scores were also statistically significant (p<0.05).

Conclusions: Our study revealed that adding HBB, an antispasmodic agent, to diclofenac and paracervical block significantly reduces pain perception during HSG compared to using diclofenac and paracervical block alone.

Keywords

Hysterosalpingography, Infertility, Pain, Diclofenac, Paracervical block, Hyoscine-N-butyl bromide, Placebo

Full Text:

PDF

References

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(2):33-43.

Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging. 2012;3(5): 475–83.

Oriji PC, Kiridi EK, Allagoa DO, Omietimi JE, Orisabinone IB, Makinde OI. Pattern of tubal pathology in infertile women undergoing hysterosalpingography at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. Yen Med J. 2020;2(1):11-7.

Kiridi EK, Oriji PC, Abasi IJ, Ubom AE, Ugwoegbu JU. Predictors or abnormal findings in infertile women undergoing hysterosalgography in Bayelsa State, South-South Nigeria. Int J Clin Obstet Gynaecol. 2022;6(2):22-30.

Kiridi EK, Oriji PC, Ugwoegbu JU, Abasi IJ. Hysterosalpingography Findings among Women Presenting for Infertility Evaluation in Bayelsa State, South-South Nigeria. J Adv Med Med Res. 2022; 34(5):7-17.

De Neubourg D, Janssens L, Verhaegen I, Smits E, Mol BW, Roelant E. Live birth after additional tubal flushing with oil-based contrast versus no additional flushing: a randomised, multicentre, parallel-group pragmatic trial in infertile women with at least one patent tube at hysterosalpingo-foam sonography (HYFOIL study). BMJ Open. 2021;11(11):e054845.

Oriji PC, Kiridi EK, Abasi IJ, Ubom AE, Ugwoegbu JU. Predictive factors for the severity of procedure-associated pain in infertile women undergoing hysterosalpingography in Bayelsa State, South-South Nigeria. Int J Trop Dis Health. 2022;43(5):43-54.

Kiridi EK, Oriji PC, Ugwoegbu JU, Abasi IJ. Effectiveness of paracervical block for pain relief in women undergoing hysterosalpingography in Bayelsa State, South-South Nigeria: a randomized control trial. Int J Clin Trials. 2022;9(2):53-9.

Omidiji OA, Toyobo OO, Adegbola O, Fatade A, Olowoyeye OA. Hysterosalpingographic findings in infertility - what has changed over the years? Afr Health Sci. 2019;19(2):1866-74.

Ahmad G, Duffy J, Watson AJS. Pain relief in hysterosalpingography. Cochrane Database Syst Rev. 2007;(2):CD006106.

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.

Hassa H, Oge T, Aydin Y, Burkankulu D. Comparison of nonsteroidal anti-inflammatory drugs and misoprostol for pain relief during and after hysterosalpingography: prospective, randomized, controlled trial. J Minim Invasive Gynecol. 2014; 21(5):762-6.

ytgat GN. Hyoscine Butylbromide: A Review of its Use in the Treatment of Abdominal?? Cramping and Pain. Drugs. 2007;67(9):1343-57.

Sekhavat L, Karbasi SA, Fallah R, Mirowliai M. Effect of hyoscine butylbromide first stage of labour in multiparus women. Afr Health Sci. 2012;12(4):408-11.

Jitchanwichai A, Soonthornpun K. Effect of Premedication hyoscine-n-butylbromide before hysterosalpingography for diagnosis of proximal tubal obstruction in infertile women: A randomized double-blind controlled trial. J Minim Invasive Gynecol. 2019;26(1):110-6.

Abbas A, Abo-Elela N, Mosa E. Effect of oral hyoscine-N-butyl bromide on pain perception during hysterosalpingography: A randomized, double-blind, placebo controlled trial. Middle East Fertil Soc J. 2017;23(1):57-62.

Aboshama RA, Shareef MA, AlAmodi AA, Kurdi W, Al-Tuhaifi MM, Bintalib MG, et al. The effect of hyoscine-N-butylbromide on pain perception during and after hysterosalpingography in infertile women: a systematic review and meta-analysis of randomised controlled trials. Hum Fertil Camb Engl. 2020;3:1-8.

Chalazonitis A, Tzovara I, Laspas F, Porfyridis P, Ptohis N, Tsimitselis G. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol. 2009;38(5):199–205.

Kilcoyne A, O’Shea A, Gervais DA, Lee SI. Hysterosalpingography in endometriosis: performance and interpretation. Abdom Radiol. 2020;45(6):1680-93.

Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis. 2009;1(1):51-4.

Oriji PC, Kiridi EK, Ubom AE, Okoye CN, Oriji VK, Awotundun B. Pattern of infertility among infertile couples in a tertiary health institution in Bayelsa State, South-South Nigeria. Int J Sci Rep. 2022;8(6): 23-9.

History of the Wong-Baker FACES Pain Rating Scale. Available at: https://wongbakerfaces.org/us/ wong-baker-faces-history/. Accessed on 20 October 2021.

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.

Hotwani J, Ainapure SS. Hyoscine Butyl bromide Suppositories. Indian Med Gaz. 2000;1:217-9.

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.

Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev. 2013;9: CD005056.

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. Am J Roentgenol. 2006;187(1):86-9.

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.