Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

Background: Outpatient hysteroscopy is a clinical procedure that is used for several diagnostic and therapeutic purposes. However, the most common adverse event and reason for procedure failure is pain. Several strategies were developed to manage pain during outpatient hysteroscopy.Aim: The aim of the present study is to compare the efficacy of intrauterine lidocaine instillation and rectal diclofenac in reducing pain associated with outpatient hysteroscopy.Materials and Methods: The present study was a randomized, comparative, trial that included. 200 female patients who underwent outpatient hysteroscopy at office hysteroscopy room at early cancer detection unit of Ain-Shams Maternity Hospital. The patients were randomly allocated to receive transcervical intrauterine instillation of 5 ml 2% lidocaine or 100 mg rectal diclofenac.Results: The most common cause for undergoing infertility, followed by menorrhagia and irregular uterine bleeding. In addition, the most common findings were submucous fibroid, endometrial polyp, and intrauterine adhesion. Regarding the primary outcome of the present study, it was found that the 100 mg rectal diclofenac was more effective than intrauterine instillation of 5 ml 2% lidocaine for pain relief during outpatient hysteroscopy. Both drugs were tolerable with no observed adverse events.Conclusion: Rectal diclofenac was more effective than local anesthetic in pain relief during outpatient hysteroscopy. This technique may be ideal for outpatient diagnostic hysteroscopy. However, further well-designed studies are still needed to confirm this finding.