Para-cervical Block and Conscious Sedation in Operative Hysteroscopy: A Comparative Study

Abstract

Background: Hysteroscopic surgery is an effective and safe method and has the advantages of rapid recovery, early return to normal activities and reduced hospital stay for the patient. Aim of the Work: prospective randomized control trial was to compare combined paracervical block and conscious sedation versus the separated use during operative hysteroscopy in terms of pain control and patient satisfaction. Patients and Methods: This study was carried out in conducted at Ain Shams University hospital at early cancer detection and endoscopy unit from November 2016 till March 2019. Patients meeting the eligibility requirements of the study were randomly assigned to receive either paracervical block, conscious sedation or both. Ninety Six patients were studied. These patients were randomized into three equal groups (32 patients in each group), using a computer generated randomization: Group I (Paracervical block), Group II (conscious sedation), and Group III (Paracervical block in conjunction with conscious sedation). Each patient was signed an informed consent form for the procedure and anesthesia. Results: On comparison of the three groups as regards overall patient satisfaction. there was a higher percentage of patients satisfaction in group III 82.8% compared to 75% in group II and 72% in group I and the difference is not significant statistically. This table shows the least satisfaction among patients was in group I cervical block 72% and 28% were not satisfied. Regarding Correlation coefficient between the number of CS previously done and the mean pain scores during cervical dilatation, intra operative and post-operative a highly significant positive correlation between number of CS and the pain score during cervical dilatation. Also there was a highly significant positive correlation between number of CS and pain score intra operative. A significant positive correlation between number of CS and pain score after 15 minutes. No correlation between number of CS and pain scores after one hour and three hours. Conclusion: Para-cervical block combined conscious sedation in operative hysteroscopy shows better than paracervical block alone or conscious sedation alone; as regard intraoperative and postoperative pain score and also during cervical dilatation and the need for general anesthesia and patient satisfaction.