Effect of Intramuscular Hyoscine-N-Butyl Bromide on Tubal Spasm and Pain Perception in Women with Infertility Undergoing Hysterosalpingography: A Randomised Controlled Trial
DOI:
https://doi.org/10.30442/ahr.0803-04-171Abstract
Background: A tubal patency test is essential in evaluating women with infertility. Hysterosalpingography (HSG) is the investigation of choice for assessing tubal patency.
Objective: To evaluate the effect of intramuscular hyoscine-N-butyl bromide on tubal spasms and pain perception during hysterosalpingography.
Methods: This randomized, controlled trial was conducted at the Radiology Departments and Infertility Clinics of four health institutions in Bayelsa State, Nigeria, between January 2021 and April 2022. Five hundred and twenty infertile women undergoing hysterosalpingography were randomized into two groups. Women in group I (control) received a placebo, while women in Group II (experimental) received 20 mg of intramuscular hyoscine-N-butyl bromide. Pain scores at different steps of the procedure were recorded.
Results: The overall mean pain scores progressively decreased from contrast instillation (4.97 ± 2.08) through 30-minutes post-procedure (3.54 ± 1.54) to 24 hours post-procedure (1.96 ± 1.78). Pain scores at contrast instillation, 30 minutes and 24 hours after HSG were significantly lower in the hyoscine group compared to the placebo group (p = 0.001 each). There were significantly fewer women with tubal blockage in the hyoscine group compared to the placebo group [78 (30.0%) vs 131 (50.4%); p = 0.001].
Conclusion: Intramuscular hyoscine-N-butyl bromide before hysterosalpingography significantly reduces pain and tubal spasm during the procedure.
References
Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging 2012; 3: 475–483. https://doi.org/10.1007/s13244-012-0183-y.
De Neubourg D, Janssens L, Verhaegen I, Smits E, Mol BW, Roelant E. Live birth after additional tubal flushing with oil-based contrast versus no additional flushing: a randomized, multicentre, parallel-group pragmatic trial in infertile women with at least one patent tube at hysterosalpingo-foam sonography (HYFOIL study). BMJ Open 2021; 11: e054845. https://doi.org/10.1136/bmjopen-2021-054845.
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: 1866–1874. https://doi.org/10.4314/ahs.v19i2.9.
Ahmad G, Duffy J, Watson AJS. Pain relief in hysterosalpingography. Cochrane Database Syst Rev 2007; (2): CD006106. https://doi.org/10.1002/14651858.CD006106.pub2.
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: 107–111. 10.1155/2015/306248.
Hassa H, Oge T, Aydin Y, Burkankulu D. Comparison of non-steroidal anti-inflammatory drugs and misoprostol for pain relief during and after hysterosalpingography: prospective, randomized, controlled trial. J Minim Invasive Gynecol 2014; 21: 762–766. https://doi.org/10.1016/j.jmig.2014.02.014.
Tytgat GN. Hyoscine butyl bromide: a review of its use in the treatment of abdominal cramping and pain. Drugs 2007; 67: 1343–1357. https://doi.org/10.2165/00003495-200767090-00007.
Sekhavat L, Karbasi SA, Fallah R, Mirowliai M. Effect of hyoscine butylbromide first stage of labour in multiparous women. Afr Health Sci 2012; 12: 408–411. https://doi.org/10.4314/ahs.v12i4.1.
Jitchanwichai A, Soonthornpun K. Effect of Premedication Hyoscine-N-Butylbromide before Hysterosalpingography for Diagnosis of Proximal Tubal Obstruction in Infertile Women: A Randomized Double-Blind Controlled Trial. J Minim Invasive Gynecol 2019; 26: 110–116. https://doi.org/10.1016/j.jmig.2018.03.034.
Abbas A, Abo-Elela N, Mosa E. Effect of oral hyoscine-N-butyl bromide on pain perception during hysterosalpingography: A randomized, double-blind, placebo-controlled trial. Middle East Fertil Soc J 2017; 23: 57–62. https://doi.org/10.1016/j.mefs.2017.08.004.
Aboshama RA, Shareef MA, AlAmodi AA, Kurdi W, Al-Tuhaifi MM, Bintalib MG, et al. The effect of hyoscine-N-butylbromide on pain perception during and after hysterosalpingography in infertile women: a systematic review and meta-analysis of randomized controlled trials. Hum Fertil Camb Engl 2020; 3: 1-8. https://doi.org/10.1080/14647273.2020.1842915.
Chalazonitis A, Tzovara I, Laspas F, Porfyridis P, Ptohis N, Tsimitselis G. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol 2009; 38: 199–205. https://doi.org/10.1067/j.cpradiol.2008.02.003.
Kilcoyne A, O’Shea A, Gervais DA, Lee SI. Hysterosalpingography in endometriosis: performance and interpretation. Abdom Radiol N Y 2020; 45: 1680–1693. https://doi.org/10.1007/s00261-019-02373-w.
Zhong B. How to Calculate Sample Size in Randomized Controlled Trial? J Thorac Dis 2009; 1: 51–54.
Oriji PC, Kiridi EK, Ubom AE, Okoye CN, Oriji VK, Awotundun B. Pattern of infertility among infertile couples in a tertiary health institution in Bayelsa State, South-South Nigeria. Int J Sci Rep 2022; 8: 136-141.https://doi.org/10.18203/issn.2454-2156.IntJSciRep20221316.
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: 86. https:// doi.org/10.3389/fnhum.2019.00086.
Wong–Baker Faces Pain Rating Scale. Wikipedia 2022. Available at: https://en.wikipedia.org/w/index.php?title=Wong–Baker_Faces_Pain_Rating_Scale&oldid=1076477101. Accessed on 23 April 2022.
Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978; 37: 378–381.
Pain scale: Types, levels, and chart with faces. Med. News Today 2020. Available at: https://www.medicalnewstoday.com/articles/pain-scale. Accessed on 26 April 2022.
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. https://doi.org/10.34171/mjiri.33.31
Moro F, Selvaggi L, Sagnella F, Morciano A, Martinez D, Gangale MF, et al. Could antispasmodic drug reduce pain during hysterosalpingo-contrast sonography (HyCoSy) in infertile patients? A randomized, double-blind clinical trial. Ultrasound Obstet Gynecol 2012; 39: 260–265. https://doi.org/10.1002/uog.11089.
Imo AOC, Sunday-Adeoye I. Radiological Assessment of The Uterus and Fallopian Tubes in Infertile Women at Abakaliki, Nigeria. Niger J Clin Pract 2008; 11: 211–215.
Kiguli-Malwadde E, Byanyima RK. Structural findings at hysterosalpingography in patients with infertility at two private clinics in Kampala, Uganda. Afr Health Sci 2004; 4: 178–181.
Kiridi EK, Oriji PC, Abasi IJ, Ubom AE, Ugwoegbu JU. Predictors or abnormal findings in infertile women undergoing hysterosalpingography in Bayelsa State, South-South Nigeria. Int J Clin Obstet Gynaecol 2022; 6: 22–30. https:// doi.org/10.33545/gynae.2022.v6.i2a.1159.
Kiridi EK, Oriji PC, Ugwoegbu JU, Abasi IJ. Hysterosalpingography Findings among Women Presenting for Infertility Evaluation in Bayelsa State, South-South Nigeria. J Adv Med Med Res 2022; 34: 7–17. https://doi.org/10.9734/JAMMR/2022/v34i531292.
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: 43–54. https://doi.org/10.9734/IJTDH/2022/v43i530593.
Jareethum R, Suksompong S, Petyim S, Prechapanich J, Laokirkkiat P, Choavaratana R. Efficacy of mefenamic acid and hyoscine for pain relief during saline infusion sonohysterography in infertile women: a double-blind, randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2011; 155: 193–198. https://doi.org/10.1016/j.ejogrb.2010.11.021.
Szymusik I, Grzechocińska B, Marianowski P, Kaczyński B, Wielgoś M. Factors influencing the severity of pain during hysterosalpingography. Int J Gynaecol Obstet 2015; 129: 118–122. https://doi.org/10.1016/j.ijgo.2014.11.015.
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 Oxf Engl 2007; 22: 1335–1339. https://doi.org/10.1093/humrep/del517.
Alper MM, Garner PR, Spence JE. Hyoscine butylbromide to relieve utero-tubal obstruction at hysterosalpingography. Br J Radiol 1985; 58: 915. https://doi.org/10.1259/0007-1285-58-693-915-a.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Annals of Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.