I.V. Klyucharov^1,3, V.V. Morozov², А.А. Khasanov^{1, 3}, R.R. Kamalova¹, A.R. Klyucharova¹, S.I. Morozova¹, V.A. Avdeeva³, A.A. Paunich⁴

¹Kazan State Medical University, 49 Butlerov Str., 420012 Kazan, Russian Federation

²Division of Minimally Invasive Gynecology, Washington Hospital Medical Center, Georgetown University, Washington, DC 20010

³Republican Clinical Hospital MOH RT, 138 Orenburgskiy trakt, 420064 Kazan, Russian Federation

⁴Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202

 Klyucharov I.V. — M.D., Ph.D., Associate Professor of the Department of Obstetrics and Gynecology No. 1, e-mail: gynecolog@pisem.net

Morozov V.V. — M.D., Associate Professor, Division of Minimally Invasive Gynecology, Washington Hospital Medical Center, Georgetown University, Washington, DC 20010, e-mail: vmorozov@fpi.umaryland.edu

Khasanov A.A. — Doc. Med. Sc., Professor of the Department of Obstetrics and Gynecology No. 1, tel. (843) 236-08-73, e-mail: albirkhasanov@mail.ru

Kamalova R.R. — resident of the Department of Obstetrics and Gynecology No. 1, e-mail: regina_99@bk.ru

Klyucharova A.R. — Cand. Med. Sc., Assistant Lecturer of the Department of Allergy and Immumology, e-mail: aliluia@yandex.ru,

Morozova S.I. — resident of the Department of Obstetrics and Gynecology No. 1, e-mail: eremka91@mail.ru

Avdeeva V.A. — anesthesiologist-resuscitator, e-mail: viktavdeeva@gmail.com

Paunich A.A. — MS in Health Management System, Quality Analyst of the Quality & Patient Safety Department, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, e-mail: apaunic@mdmercy.com

The article was submitted on: 24 November 2017, accepted for publication on: 13 April 2018

Vazovagal reactions (VVR) are viewed as complications of in-office hysteroscopy which can lead to negative health sequels. The purpose of the work was to assess the frequency and clinical significance of VVR and a level of painful sensations in the course of in-office hysteroscopy by Betocchi method. The occurrence of VVR in the course of in-office hysteroscopy was recorded according to the characteristic clinical picture, along with the complications specific to hysteroscopy and the determination of the level of pain sensations. The study involved 370 patients with intra-uterine pathology confirmed by pelvic ultrasound. The operations were performed without anesthesia in the surgical suite of the women’s clinic using “no-touch” Betocchi technique. The level of pain was assessed according to the VAS pain scale in 2 stages: at the stage of the hysteroscope introduction, examination of the uterus cavity (diagnostic stage) and at the stage of operative intervention (surgical stage). VVR were diagnosed in 4 cases (1.1%). The clinical picture of the reaction developed during 3 polypectomies and 1 myomectomy and was characterized as a typical VVR. There were no other complications during the in-office hysteroscopy. At the diagnostic and surgical stages, the level of pain was within the limits corresponding to mild pain (1-3 points). The low level of VR (1.1%) and the low level of pain confirm the good tolerability and safety of in-office hysteroscopy.

Keywords: Vasovagal reaction, in-office hysteroscopy, complications, pain assessment, visual-analog scale.

(For citation: Klyucharov I.V., Morozov V.V., Khasanov А.А., Kamalova R.R., Klyucharova A.R., Morozova S.I., Avdeeva V.A., Paunich A.A. Vasovagal attacks and level of painful sensations during office hysteroscopy in Betocchi mode. Practical Medicine. 2018)

REFERENCES

1. Finikiotis G. Side-effects and complications of outpatient hysteroscopy. Aust N Z J Obstet Gynaecol., 1993; 33:61-2.
2. Saveleva G.M., Breusenko V.G., Kappusheva L.M. Diagnosticheskaya gisteroskopiya [Diagnostic hysteroscopy]. Gisteroskopiya: atlas i rukovodstvo. Moscow: GEHOTAR Media, 2014. 248 p.
3. Agostini A., Bretelle F., Ronda I., Roger V., Cravello L, Blanc B. Risk of vasovagal syndrome during outpatient hysteroscopy. J. Am. Assoc. Gynecol. Laparosc., 2004; 11(2): 245–7.
4. Brevik H., Borchgrevink P.C., Allen S.M. et al. Assessment of pain. British Journal of Anaesthesia, 2008, no. 101 (1), rr. 17–24.
5. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J. Minim. Invasive Gynecol, 2010, no. 17 (6), rr. 703–8.
6. Bettochi S., Nappi L., Ceci O., Santoro A. et al. (2004) The role of office hysteroscopy in menopause. J Am Assoc Gynecol Laparosc., 11:103–106.
7. Shifman E.M., Filippovich G.V. Spinal anesthesia in obstetrics. Neyrofiziologicheskie osnovy spinnomozgovoy anestezii. Regionarnaya anesteziya i lechenie ostroy boli, 2012, 6(3): 58–65 (in Russ.).
8. Cooper N.A., Khan K.S., Clark T.J. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ, 2010; 340: c1130.
9. De Iaco P., Marabini A., Stefanetti M., Del Vecchio C., Bovicelli L. Acceptability and pain of outpatient hysteroscopy. J Am Assoc Gynecol Laparosc., 2000;7(1):71.
10. Bagdasaryan A.R., Sarkisov S.Eh. Complications of diagnostic and operative hysteroscopy. Akusherstvo i ginekologiya, 2014, no. 1, pp. 36–40 (in Russ.).
11. Davydov A.I., Strizhakov A.N., Novruzova N.Kh. Complications of operative hysteroscopy: prevention and treatment. Voprosy ginekologii, akusherstva i perinatologii, 2016, vol. 15, no. 6, pp. 52–60 (in Russ.).
12. Techieva Zh.S., Gogichaev T.K. Possibilities of modern diagnostics of intrauterine pathology in outpatient conditions. Meditsinskaya nauka i obrazovanie Urala, 2014, vol. 15, no. 1 (77), pp. 101–105 (in Russ.).
13. Korennaya V.V. Ambulatory hysteroscopy. Practical recommendations. Consilium Medicum., 2015; 06: 28–31 (in Russ.).