Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy

Editor—Hysteroscopy is a diagnostic gynaecological procedure traditionally requiring administration of general anaesthesia, but more frequently completed using local anaesthesia within a day-case (ambulatory) setting. Advantages associated with this transition include decreased completion times, fewer risks, and lower clinical costs. 1 Bajaj Y. Sethi N. Carr S. Knight L.C. Endoscopic sinus surgery as day-case procedure. J Laryngol Otol. 2009; 123: 619-622 Crossref PubMed Scopus (15) Google Scholar ,2 Anderson T. Walls M. Canelo R. Day case surgery guidelines. Surgery. 2017; 35: 85-91 Scopus (8) Google Scholar However, maintaining patient satisfaction remains a high priority, as the risk of pain and discomfort is a primary concern. 3 Marsh F.A. Rogerson L.J. Duffy S.R.G. A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy. BJOG. 2006; 113: 896-901 Crossref PubMed Scopus (52) Google Scholar Multiple sources in the UK describe this procedure as non-painful, although this description is being challenged by public campaigns. Numerous services advertise the procedure as being either pain free or low pain; however, it is estimated that 25% of patients report experiencing intense or intolerable pain. 4 Jansen F.W. Vredevoogd C.B. van Ulzen K. Hermans J. Trimbos J.B. Trimbos-Kemper T.C. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol. 2000; 96: 266-270 Crossref PubMed Scopus (315) Google Scholar For severe pain, local anaesthetic can be administered, but this does not guarantee effective pain management. 5 Meechan J.G. Why does local anaesthesia not work every time?. Dent Update. 2017; 32: 66-72 Crossref Scopus (16) Google Scholar