Effectiveness of interventions for pain relief in hysterosalpingography: A network meta-analysis and systematic review

Objective: We aimed to evaluate the effectiveness of placebo, oral opioid analgesic (OOA), intravenous opioid analgesic (IOA), non-opioid analgesic (NOA), topical anesthetic (TA) and locally injected anesthetic (LIA) for pain relief during hysterosalpingography (HSG) using a Bayesian network meta-analysis of data from randomized controlled trials. Methods: PUBMED, EMBASE, and CENTRAL search engines were used to search and identify clinical trials that evaluated interventions for pain relief in HSG. Methodological studies quality was assessed by the Cochrane Collaboration tool for assessing risk of bias. Result: Sixteen trials involving 1263 participants were included in this study. IOA got excess but not statistically significant lower visual analogue score (VAS) pain score during HSG or more than 30 minutes after HSG compared with the other groups. OOA resulted in excess but not statistically significant higher VAS pain score during HSG compared with the other groups except placebo group. According to SUCRA regarding the lower VAS pain score during HSG, the treatments rank was the following: IOA, TA, NOA, LIA, OOA and placebo; as regard lower VAS pain score at 30 minutes or more after HSG, the treatments rank was the following: IOA, LIA, OOA, TA, NOA and placebo. Conclusion: This new Bayesian data network meta-analysis from randomized controlled trials demonstrated that IOA resulted in the highest probability to reduce the pain during HSG or at 30 minutes or more after HSG among the six interventions considered.