Sublingual Piroxicam for Relief of Pain during Diagnostic Hysteroscopy a Randomized Controlled Trial

Objective: The aim of the current trial was to evaluate the efficacy of sublingual piroxicam prior to office hysteroscopy in reducing the procedure-related pain. Methods: The current placebo-controlled randomized clinical trial was conducted at the Early Cancer Detection Unit (ECDU) at Ain Shams University Maternity Hospital. The study included women planned to undergo office (diagnostic) hysteroscopy for various indications. The recruited women were randomized into one of two groups: group I, including women who received piroxicam 20 mg sublingual tablets; and group II, including women who received an antacid/antiflatulent tablet (as a placebo) containing calcium carbonate 420 mg plus dimethicone 10 mg. The primary outcome was pain. Pain was assessed using a 10-cm visual analogue scale. Secondary outcomes included the procedure duration, rate of failed procedure, the level of difficulty of the procedure, as well as, the patient's acceptability. Results: The mean age of included women was 34.8 ± 9.5 years (range: 22-37 years). The median 10-cm VAS for pain was significantly lower in women of group I [Piroxicam Group] [median (IQR): 4 (3-7) vs. 5 (4-8), respectively, p=0.031]. The proportion of women who had moderate/severe pain was lower, but not to a significant level, in women of group I. There were no significant differences between women of both groups regarding the procedure duration, as well as, for the rates of failed or difficult procedure. Conclusion: Sublingual piroxicam prior to office hysteroscopy seems to be significantly associated with less procedurerelated pain, yet with no significant effect on the procedure duration, or the rates of failed or difficult procedure.