A systematic review of the effect of the distension medium on pain during outpatient hysteroscopy.

OBJECTIVE: To assess the effect of distension medium on pain during outpatient hysteroscopy. DESIGN: Systematic review and meta-analysis. SETTING: Outpatient hysteroscopy clinics. PATIENT(S): Women undergoing outpatient hysteroscopic examination. INTERVENTION(S): Use of normal saline versus carbon dioxide as distension medium for outpatient hysteroscopy. MAIN OUTCOME MEASURE(S): Pain scores. RESULT(S): There was no statistically significant difference in pain scores when carbon dioxide or normal saline were used as the distension medium for outpatient hysteroscopy (standardized mean differences = -0.05; 95% CI, -0.17 to 0.07; I(2) = 92%). CONCLUSION(S): Carbon dioxide and normal saline are both suitable distending media for outpatient hysteroscopy as the procedural pain is comparable and the views obtained are satisfactory. However, normal saline does confer advantages that may make it more suitable for clinical use.