The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS: Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS: Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS: Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.

Does Ultrasound Guidance Provide Pain Relief During Intrauterine Contraceptive Device Insertion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: To evaluate ultrasound guidance effect in pain relief during intrauterine device (IUD) insertion. METHODS: Four different databases were searched from inception till June 2022. We selected randomized controlled trials (RCTs) that compared transabdominal ultrasound guidance versus traditional non-guided IUD insertion among women undergoing IUD placement for contraception. We used Revman software during performing our meta-analysis. Our primary outcome was the pain score during IUD insertion as evaluated by the Visual Analog Scale (VAS). Our secondary outcomes were the procedure insertion time, satisfaction, and incidences of complications and misplaced IUDs. RESULTS: Seven RCTs were retrieved with a total number of 1267 patients. There was a significant reduction in the VAS pain score during IUD insertion among the ultrasound-guided group (MD = -1.91, 95% CI [-3.08, -0.73], P = .001). The procedure insertion time was significantly shorter within the ultrasound guidance group compared with the control group (MD = -1.35, 95% CI [-1.81, -0.88], P < .001). Moreover, more women were significantly satisfied with the procedure among the ultrasound-guided group (P < .001). In addition, ultrasound-guided IUD insertion was linked to significant decline in incidences of complications and misplaced IUDs. CONCLUSION: Ultrasound guidance can be used as a modified technique during IUD insertion as it decreases pain, procedure time, and rates of complications and misplaced IUDs with better patient satisfaction.

The Effect of Erector Spinae Plane Block With and Without Addition of Magnesium on Relief of Pain from Post-herpetic Neuralgia.

BACKGROUND: The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics. OBJECTIVES: The objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN. STUDY DESIGN: Randomized controlled double-blinded trial. SETTING: A single university center. METHODS: A total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient's satisfaction were measured and recorded. RESULTS: In comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients' satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P ? 0.05). LIMITATIONS: The study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture. CONCLUSION: ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.