Burak ERSAK, Yasemin TAŞÇI, Rahime BEDİR FINDIK, Duygu TUĞRUL ERSAK, Aytekin TOKMAK, Mahmut Kuntay KOKANALI

Histerosalpingografide Kullanılan İyotlu Kontrast Maddenin Vücut Sıcaklığında ya da Oda Sıcaklığında Uygulanmasının Vizüel Analog Skala Skorlarına Etkisi

Amaç: İnfertil hastalarda soğuk ve sıcak kontrast madde kullanılarak çekimi yapılan histerosalpingografi (HSG) işlemi sırasında ve sonrasında vizüel analog skalası (VAS) kullanarak ağrı skorlarını karşılaştırmak ve sıcak kontrast kullanımının spontan gebelik oranını değiştirip değiştiremeyeceğini araştırmak. Gereçler ve Yöntem: Çalışma prospektif randomize kontrollü tasarlandı ve Mart-Eylül 2017 tarihleri arasında HSG prosedürü uygulanan primer infertil hastalar dahil edildi. Hastaların yaşı, vücut kitle indeksi (VKİ), geçirilmiş cerrahi öyküsü, infertilite süresi ve en ağrılı adet dönemindeki ağrı düzeyleri kaydedildi. İşlem sırasında ve işlem sonrası 30. dakikada ağrı şiddeti VAS ile sorgulandı. Hastaların yaşı, vücut kitle indeksi (VKİ), geçirilmiş cerrahi öyküsü, infertilite süresi ve en ağrılı adet dönemindeki ağrı düzeyleri kaydedildi. İşlem sırasında ve işlem sonrası 30. dakikada ağrı şiddeti VAS ile sorgulandı. Bulgular: Gruplar arasında yaş, VKİ, infertilite süresi, geçirilmiş cerrahi ve menstrüasyon sırasındaki VAS açısından istatistiksel olarak anlamlı fark yoktu. Sıcak gruptaki hastaların ortalama HSG süresi anlamlı olarak daha düşüktü (p=0,001). Sıcak gruptaki hastaların HSG sırasındaki ve 30 dakika sonraki ortalama VAS skoru, kontrol grubuna göre (sırasıyla 5,3±4,2 vs 7,5±2,0) (1.1±0,9 ve 2,4±1,4) anlamlı derecede düşüktü. HSG sırasında şiddetli ağrı yüzdesi sıcak grupta %25.5 iken kontrol grubunda %66.7 idi. Lojistik regresyon analizinde, iki grup arasında işlem sırasında hissedilen şiddetli ağrı için yalnızca anlamlı ilişkili faktörler olarak bulundu (p

Anahtar Kelimeler:

Histerosalpingografi, iyotlu kontrast madde, pelvik ağrı, sıcak kontrast madde

The Effect of Applying the Iodized Contrast Materials Used in Hysterosalpingography at Body Temperature or Room Temperature on Visual Analogue Scale Scores

Aim: To compare pain scores of infertile patients during and after hysterosalpingography (HSG) procedure using visual analoge scale (VAS) between cold and warm contrast medium and to investigate whether using warm contrast can alter spontaneous pregnancy rate. Materials and Methods: Prospective randomized study between March-September 2017. Primary infertile patients undergoing HSG procedure. Patients’ age, body mass index (BMI), history of previous surgery, duration of infertility and pain levels during the most painful menstrual period were recorded. The pain severity was questioned during and at the 30th minute after the procedure using VAS. While patients who underwent HSG using a contrast medium at body temperature 37 °C were defined as warm group(n:55), patients who underwent HSG using a contrast medium at room temperature 23 °C were defined as cold group (n:55). Results: There were no significant differences between the groups in terms of age, BMI, duration of infertility, previous surgery and VAS during menstruation. The mean duration of HSG of warm group patients was significantly lower(p=0.001). Warm group patients’ mean VAS score during and 30 minutes after HSG were significantly lower than in the control group ( 5.3±4.2 vs 7.5±2.0), (1.1±0.9 vs 2.4±1.4), respectively. While severe pain percentage during HSG in warm group was 25.5%, it was 66.7% in the control group. In logistic regression analysis, warm and cold groups were only found as significant related factors for severe pain felt during procedure (p

Keywords:

Hysterosalpingography, iodinated contrast media, pelvic pain warm contrast media, visual analogue scale.,

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1. Liberty G, Gal M, Halevy-Shalem T, Michaelson-Cohen R, Galoyan N, Hyman J, et al. Lidocaine–Prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study. Hum Reprod. 2007;22(5):1335-9.
2. Roma Dalfó A, Úbeda B, Úbeda A, Monzón M, Rotger R, Ramos R, et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. American Journal of Roentgenology. 2004;183(5):1405-9.
3. 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.
4. Maddox TG. Adverse Reactions to Contrast Material. Recognition, Prevention and Treatment. Am Fam Physician. 2002;66(7):1229.
5. Shalev J, Krissi H, Blankstein J, Meizner I, Ben-Rafael Z, Dicker D. Modified hysterosalpingography during infertility work-up: use of contrast medium and saline to investigate mechanical factors. Fertil Steril. 2000;74(2):372-5.
6. Erkılınç S, Kala NA, Pekcan MK, Güzel Aİ, Çınar M, Yılmaz N. The effect of a pre-procedure information video on anxiety levels in patients undergoing hysterosalpingography: A prospective case-control study. Journal of the Turkish German Gynecological Association. 2018;19(3):137.
7. Ahmad G, Duffy JM, O'Flynn H, Watson A. Pain relief in hysterosalpingography. Cochrane Database Syst Rev. 2007(2).
8. Lindequist S, Justesen P, Larsen C, Rasmussen F. Diagnostic quality and complications of hysterosalpingography: oil-versus water-soluble contrast media--a randomized prospective study. Radiology. 1991;179(1):69-74.
9. Sammour T, Kahokehr A, Hill A. Meta‐analysis of the effect of warm humidified insufflation on pain after laparoscopy. British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery. 2008;95(8):950-6.
10. Zheng Z-H, Anderstam B, Qureshi AR, Heimbürger O, Wang T, Södersten P, et al. Heat sterilization of peritoneal dialysis solutions influences ingestive behavior in non-uremic rats. Kidney Int. 2002;62(4):1447-53.
11. Nirmal D, Griffiths A, Jose G, Evans J. Warming Echovist contrast medium for hysterocontrastsonography and the effect on the incidence of pelvic pain. A randomized controlled study. Hum Reprod. 2006;21(4):1052-4.
12. Zhu Y-Y, Mao Y-Z, Wu W-L. Comparison of warm and cold contrast media for hysterosalpingography: a prospective, randomized study. Fertil Steril. 2012;97(6):1405-9. 13. Baramki TA. Hysterosalpingography. Fertil Steril. 2005;83(6):1595-606.
14. Chauhan MB, Lakra P, Jyotsna D, Nanda S, Malhotra V. Pain relief during hysterosalpingography: role of intracervical block. Arch Gynecol Obstet. 2013;287(1):155-9.
15. Horwitz R, Morton P, Shaff M, Hugo P. A radiological approach to infertility—hysterosalpingography. The British journal of radiology. 1979;52(616):255-62.
16. Safi F, Kamali A, Rezaei M, Rezaei M, Rafiei M. Effect of intramuscular hyoscine-n-butyl bromide on fallopian tube spasm and pain perception during and after hysterosalpingography in infertile women: A randomized single-blind controlled clinical trial. Med J Islam Repub Iran. 2019;33:31.
17. Hindocha A, Beere L, O'Flynn H, Watson A, Ahmad G. Pain relief in hysterosalpingography. Cochrane Database Syst Rev. 2015(9).
18. Gupta N, Ghosh B, Mittal S. Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography. International Journal of Gynecology & Obstetrics. 2008;102(3):284-6.
19. Wang D, Cheng X, Fang H, Ren Y, Li X, Ren W, et al. Effect of cold stress on ovarian & uterine microcirculation in rats and the role of endothelin system. Reprod Biol Endocrinol. 2020;18:1-13.
20. Sammour T, Kahokehr A, Hill A. Meta‐analysis of the effect of warm humidified insufflation on pain after laparoscopy. Br J Surg. 2008;95(8):950-6.
21. Sajid MS, Mallick AS, Rimpel J, Bokari SA, Cheek E, Baig MK. Effect of heated and humidified carbon dioxide on patients after laparoscopic procedures: a meta-analysis. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2008;18(6):539-46.
22. Balayssac D, Pereira B, Bazin J-E, Le Roy B, Pezet D, Gagniere J. Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature. Surg Endosc. 2017;31(1):1-12.
23. Van Welie N, Dreyer K, Van Rijswijk J, Verhoeve H, Goddijn M, Nap A, et al. Treatment effect of oil-based contrast is related to experienced pain at HSG: a post-hoc analysis of the randomised H2Oil study. Hum Reprod. 2019;34(12):2391-8.
24. Dreyer K, van Eekelen R, Tjon-Kon-Fat R, van der Steeg J, Steures P, Eijkemans M, et al. The therapeutic effect of hysterosalpingography in couples with unexplained subfertility: a post-hoc analysis of a prospective multi-centre cohort study. Reprod Biomed Online. 2019;38(2):233-9.
25. Johnson NP. Review of lipiodol treatment for infertility–an innovative treatment for endometriosis‐related infertility? Aust N Z J Obstet Gynaecol. 2014;54(1):9-12.
26. Izumi G, Koga K, Takamura M, Bo W, Nagai M, Miyashita M, et al. Oil-soluble contrast medium (OSCM) for hysterosalpingography modulates dendritic cell and regulatory T cell profiles in the peritoneal cavity: a possible mechanism by which OSCM enhances fertility. The Journal of Immunology. 2017;198(11):4277-84.
27. Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BWJ, Johnson N, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2015(5).