The effect of intracervical lidocaine versus intramuscular diclofenac for pain relief during hysterosalpingography among infertile women in a tertiary hospital in Kano: a randomised controlled trial

Abstract

Background: Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes and is used predominantly in the evaluation of infertility. HSG can cause discomfort or pain during or after the procedure, up to 72 % of women complain of significant discomfort with this test. This pain can hinder patient’s co-operation, therefore limiting the usefulness of the procedure, and willingness to do other similar diagnostic studies. It can also result in fortuitous tubal blockade by provoking cornual spasms.

Objectives: To compare the effect of intracervical block with 1% lidocaine and intramuscular diclofenac 75mg in decreasing pain perception during hysterosalpingography.

Methods: The study was carried out between September 2016 and January 2017. One hundred and forty women with infertility referred for hysterosalpingography were randomly recruited and assigned to two study groups. Women in the study group A were given an intracervical block with 1% lidocaine while women in the Study Group B were given intramuscular diclofenac sodium 75mg 30 minutes before the procedure. Pain levels during specified stages of HSG were assessed using visual analogue score. The statistical package for social sciences (SPSS) version 16.0 was used to analyze the data. The data obtained were presented in tables. Categorical data were analyzed using chi-squared test and Fishers exact correction, continuous data were analyzed using student t-test; level of significance (p-value) was set at p< 0.05.

Results: There was no statistically significant difference in the two study groups in their baseline characteristics; but there were statistically significant differences in some gynaecological characteristics that include previous vaginal delivery and previous pregnancy loss. The two most painful steps of the procedure were during grasping of the cervix and uterine distension with contrast medium mean visual analogue score (VAS) of 4.26±1.62 and 6.37±1.62 (t = -7.726, p-value <0.001), 6.14±1.85 and 7.37±2.23 (t = -3.543 p-value 0.001) respectively in groups A and B.

Conclusion: There was significant reduction in VAS pain scores with intracervical block with lidocaine when performing HSG for infertility.