Comparison of paracetamol and diclofenac as prophylactic analgesics during hysterosalpingography in Bayelsa State, South-South Nigeria: a randomized controlled trial

Authors

  • Enefia Kelvin Kiridi Department of Radiology, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria Silhouette Radiodiagnostic Consultants, Yenagoa, Bayelsa State, Nigeria http://orcid.org/0000-0002-0151-5466
  • Peter Chibuzor Oriji Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria Silhouette Radiodiagnostic Consultants, Yenagoa, Bayelsa State, Nigeria
  • Johnpatrick Uchenna Ugwoegbu Department of Radiology, Federal Medical Centre, Owerri, Imo State, Nigeria
  • Akaninyene Eseme Ubom Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
  • Isaac Joel Abasi Department of Obstetrics and Gynaecology, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20221339

Keywords:

Hysterosalpingography, Pain, Paracetamol, Diclofenac, Bayelsa

Abstract

Background: Hysterosalpingography is the investigative modality of choice for the evaluation of the uterine cavity, fallopian tubes, and adjacent peritoneal cavity. Objective were to compare the effectiveness of paracetamol and diclofenac in pain relief during hysterosalpingography.

Methods: This 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 June 2021-March, 2022, and 380 infertile women undergoing hysterosalpingography were equally randomised into two groups. Group I received paracetamol, while group II received diclofenac prior to the procedure. Data were analysed using statistical product and service solutions for Windows® version 25. Student’s t-test was used to compare sample means, and the Chi-square test was used to compare the proportions.

Results: The women experienced the least pain during insertion of speculum, with an overall mean pain score at this step of 0.8±0.9, while the most painful step was instillation of contrast, the overall mean pain score at this step being 4.3±1.9. While 38, 20.0%, women in the paracetamol group expressed severe pain during contrast instillation, only 14, 7.4%, women in the diclofenac group expressed severe pain at this step, and this was statistically significant (ꭓ2=22.05; p=0.001). The mean pain scores at all steps of the procedure were significantly higher in the paracetamol group than in the diclofenac group (p≤0.005).

Conclusions: Compared to paracetamol, diclofenac is a more effective analgesic for pain relief during hysterosalpingography.

Metrics

Metrics Loading ...

Author Biography

Enefia Kelvin Kiridi, Department of Radiology, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria Silhouette Radiodiagnostic Consultants, Yenagoa, Bayelsa State, Nigeria

Department of Obstetrics and Gynaecology.

Fellow, West African College of Surgeons.

References

Zafarani F, Ghaffari F, Ahmadi F, Soleimani Mehranjani M, Shahrzad G. Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities. Br J Radiol. 2021;94(1122):20201386.

Roest I, van Welie N, Mijatovic V. Complications after hysterosalpingography with oil- or water-based contrast: results of a nationwide survey. Hum Reprod Open. 2020;2020(1):hoz045.

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.

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.

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.

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

Hindocha A, Beere L, O’Flynn H, Watson A, Ahmad G. Pain relief in hysterosalpingography. Cochrane Database Syst Rev. 2015;(9).

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.

Duffy JMN, Ahmad G, Watson AJS. Pain relief during hysterosalpingography: a national survey. Hum Fertil Camb Engl. 2008;11(2):119-21.

Gupta N, Ghosh B, Mittal S. Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography. Int J Gynaecol Obstet. 2008;102(3):284-6.

Ahmad G, Attarbashi S, O’Flynn H, Watson AJS. Pain relief in office gynaecology: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2011;155(1):3-13.

Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21(3):201-32.

Diclofenac (Topical) Monograph for Professionals. Drugs.com. Available at: https://www.drugs.com/monograph/diclofenac-topical.html. Accessed on April 1, 2022.

Zhong B. How to Calculate Sample Size in Randomized Controlled Trial? J Thorac Dis. 2009;1(1):51–4.

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.

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. 2014;34(1):48-53.

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.

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.

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.

Tur-Kaspa I, Seidman DS, Soriano D, Greenberg I, Dor J, Bider D. Hysterosalpingography with a balloon catheter versus a metal cannula: a prospective, randomized, blinded comparative study. Hum Reprod Oxf Engl. 1998;13(1):75-7.

Karaman E, Çim N, Alkış İ, Yıldırım A, Yıldızhan R. Rectal indomethacin use in pain relief during hysterosalpingography: A randomized placebo-controlled trial. J Obstet Gynaecol Res. 2016;42(2):195-201.

Nia SS, Safi F, Shoukrpour M, Kamali A. An investigation into the effect of evening primrose in dilatation of cervix and pain during and after hysterosalpingography. J Med Life. 2019;12(3):284-9.

Costello MF, Horrowitz S, Steigrad S, Saif N, Bennett M, Ekangaki A. Transcervical intrauterine topical local anesthetic at hysterosalpingography: a prospective, randomized, double-blind, placebo-controlled trial. Fertil Steril. 2002;78(5):1116-22.

Elson EM, Ridley NT. Paracetamol as a prophylactic analgesic for hysterosalpingography: a double blind randomized controlled trial. Clin Radiol. 2000;55(9):675-8.

Downloads

Published

2022-05-24

Issue

Section

Original Research Articles