Strategies to minimize discomfort during diagnostic hysterosalpingography with disposable balloon catheters: a randomized placebo-controlled study with oral nonsteroidal premedication

Objective: To assess whether oral administration of 100 mg of nimesulide reduces pain during or after a hysterosalpingography (HSG) performed with disposable balloon catheters. Design: Prospective, randomized, placebo-controlled study. Setting: Reproductive Centre, Department of Obstetrics and Gynaecology, University of Genoa. Patient(s): Four hundred and forty patients undergoing HSG with a balloon catheter without applying a tenaculum. Intervention(s): Patients were randomized to receive either 100 mg of oral nimesulide or a placebo solution 30 minutes before the HSG was performed. Main Outcome Measure(s): Patients recorded the degree of pain experienced during the examination, 2 hours afterward, and during the following week on a questionnaire using a 10-mm visual analogue scale (VAS). Result(s): Of the 331 (75.2 %) patients who returned the questionnaire, 151 had received nimesulide and 180 placebo. There was no difference in pain score between the two groups at any study point. Pain during HSG was correlated with nulliparity and tubal occlusion. Balloon inflation (cervix versus cavity) was not related to pain. Conclusion(s): Nimesulide does not reduce pain during or after HSG when the procedure is accomplished with a balloon catheter.