| Background At present,hysterosalpingography(HSG)and transvaginal four-dimensional hysterosalpingo-contrast sonography(TV 4D-HyCoSy)are the most common methods evaluating fallopian tubal patency.Compared with the traditional method-HSG,we can observe the imaging process dynamically with TV 4D-HyCoSy and adjust the injection dosage and velocity according to the development of bilateral fallopian tubes to reduce the discomfort of the patients.Yet,pain is still the main side effect.Pain can not only affect the comfort of the examination[1],but also cause vagus nerve excitation and spastic contraction of the interstitial or isthmus of fallopian tube,resulting in false positive results.Therefore,how to alleviate the pain during and after the examination become the focus attention of clinicians and patients.Pain is the result of multiple factors.Understanding the related factors can make doctors put forward clinical prevention and treatment suggestions to prevent pain to the maximum extent.The patency of fallopian tubes in both HSG and TV 4D-HyCoSy,is reported to be one of the important factors affecting the severity of pain.However,the above studies considered the factors affecting pain relatively simple,and lacked a comprehensive analysis of the factors affecting pain.This study intends to investigate the effects of multiple factors on peak pain during examination.In order to relieve the pain,the clinician mostly uses the medicine antispasmodic analgesia.Atropine relaxes visceral smooth muscle by blocking cholinergic receptors,which is widely used by doctors as preoperative prophylactic administration in gynecological invasive examinations in order to relieve pain.Followed the operating process of HSG,atropine is also used prior to TV 4D-HyCoSy in some organizations[4,5].A variety of prescriptions including intramuscular and intrauterine administration were adopted.However,its effectiveness on pain was controversial.By using different administration methods,whether or not atropine can effectively relieve the pain has not been reported in previous studies.Our study intends to explore the problem in depth.Objectives The purpose of this article is to investigate whether atropine can effectively relieve pain during Transvaginal four-dimensional hysterosalpingo-contrast-sonography(TV 4D-HyCoSy)and the influencing factors of peak pain during examination.Methods This was a retrospective study included 340 women who underwent TV 4D-HyCoSy examination from Jan 2016 to Oct 2017.Pain was evaluated during and after TV 4D-HyCoSy.1.Comparison of pain score among groups with different injection methodsAll patients were divided into three groups according to different injection methods.(1)Non-atropine group:5ml saline was injected into uterine cavity after placement of catheter and balloon.(2)Intrauterine injection group:5 ml diluted atropine solution(0.25mg)was injected into uterine cavity after placement of catheter and balloon.(3)Intramuscular injection group:1ml atropine sulfate was administrated by intramuscular injection 30 minutes before the examination and 5ml saline was injected into the uterine cavity after placement of catheter and balloon.Explore whether there are differences in pain scores at T0～T5 between different injection modes and when peak pain occurs.2.Incidence and related factors of severe painCompare the pain scores of each time point among different groups with different injection methods.The patients were divided into severe pain group(VAS>6)and non-severe pain group(VAS≤6).Record basic data of the patients,such as age,type of infertility,history of pelvic inflammation,history of pelvic surgery,history of uterine manipulation,history of ectopic pregnancy,uterine location,uterine malformation,uterine cavity lesion,fibroid,polycystic ovary,ovarian endometriomas,dysmenorrhea score,the degree of patency of fallopian tube,the dosage of contrast agent.Explore the correlation between the above 15 factors and the occurrence of severe pain.Results1.Basic DataTV 4D-HyCoSy was performed in 340 cases of infertile women in our hospital,including 117 cases of primary infertility,125 cases of secondary infertility and 98 cases without reaching the standard of infertility who were requesting for the examination.The average age of the subjects was 30.37±5.12 years old.The average duration of infertility was 1.601±1.53 years.The factors,including patient’s age,type of infertility,history of pelvic inflammation,history of pelvic surgery,history of uterine operation,history of ectopic pregnancy,uterine location,uterine malformation,uterine cavity lesion,fibroid,polycystic ovary,ovarian endometriomas,dysmenorrhea score,degree of patency of fallopian tube and contrast agents dosage,were classified and recorded.2.Comparison of pain score among groups with different injection methodsThere were 96 patients in the Non-atropine group 151 patients in the intramuscular injection group,and.93 patients in the intrauterine injection group.There were no significant differences among the three groups in basic datas.There was no significant differences among Non-atropine group,intrauterine injection group and intramuscular injection group in pain scores at every time point(from T0 to Ts,P>0.05).The time with highest pain score in either groups was T3(the time point of contrast medium injection).The pain scores were 5.52±2.50(Non-atropine group),5.87±2.73(intramuscular injection group),5.77±2.5 1(intrauterine injection)respectively3.Incidence and related factors of severe pain at T3No matter what atropine delivery mode was used,the highest time point of pain was T3(contrast medium injection),so the pain during injection of contrast medium was graded and compared.Among the 340 patients,severe pain occurred in 138 cases(40.6%)when contrast medium was injected.The pain scores of patients with severe pain and non-severe pain were 8.37 ± 1.18 and 3.95 ± 1.57 respectively.Take these 15 factors and T3(contrast medium injection)pain score into univariate analysis respectively:age,type of infertility,history of pelvic inflammation,pelvic surgery,history of uterine manipulation,history of ectopic pregnancy,uterine location,uterine malformation,uterine lesion,fibroid,polycystic ovary,ovarian endometriomas,dysmenorrhea score,the degree of patency of fallopian tube and contrast agents dosage.We find that there was significant difference between the non-severe pain group and the severe pain group in age(P=0.011),dysmenorrhea score(P=0.001)and the patency of fallopian tube(P<0.001).In other words,the three factors were the related factors when severe pain occurred.In addition,there was no statistically significant difference in the incidence of severe pain in other factors.The sample of ovarian endometriomas was rejected because of small sample size when severe pain occurred(N=1).The three factors related to the outcome selected by univariate analysis were brought into binary logistic regression analysis,and the optimal model was obtained.The model showed that the three factors were all significant factors.That is to say,age,dysmenorrhea score and tubal patency were all independent influencing factors of severe pain.The younger,the higher dysmenorrhea score,the lower the degree of tubal patency,the more prone to severe pain.Conclusion 1.Before TV 4D-HyCoSy,neither intramuscular injection of atropine nor intrauterine injection of atropine can reduce pain in TV 4D-HyCoSy.2.The peak pain occurred when contrast medium was injected,and the intensity of the pain was the result of multiple factors,in which age,dysmenorrhea score and tubal patency play an important role in the incidence of severe pain. |
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