• Cristina Del Valle Rubido, Juan Antonio Solano Calvo, Antonio Rodríguez Miguel, Juan José Delgado Espeja, Jerónimo González Hinojosa, and Álvaro Zapico Goñi.
• Department of Obstetrics and Gynecology, Hospital Universitario Príncipe de Asturias, Madrid, Spain. Electronic address: cristinadelvallerubido@gmail.com.
• J Minim Invasive Gynecol. 2015 May 1;22(4):595-600.

Study ObjectiveTo show the decrease in pain and better tolerance to inhalation analgesia with a 50% equimolar mixture of nitrogen protoxide and oxygen in hysteroscopic polypectomy compared with paracervical anesthesia and a control group.DesignOne hundred six patients scheduled for office hysteroscopy and polypectomy were divided into the following 3 groups: the control group, the nitrous oxide group, and the paracervical infiltration group. Patients were assigned sequentially (Canadian Task Force classification II-1).SettingThe study took place in a hysteroscopy outpatient clinic under the supervision of a gynecologist and 2 nurses trained to cooperate in the trial.PatientsOne hundred six women from Area III of Madrid Community, Spain, who had been diagnosed with endometrial polyps at a gynecology office and were scheduled for office hysteroscopy and polypectomy agreed to participate in the study.InterventionsPatients in group 1 (control group) received no treatment. Group 2 received inhaled nitrous oxide and group 3 paracervical infiltration with 1% lidocaine.Measurements And Main ResultsPain was assessed using the visual analog scale (0-10). Pain perceived by patients was lower in the nitrous Oxide group (mean: 3.55 ± 0.60, median: 3) versus the control group (mean: 5.49 ± 1.88, median: 6, p < .05) and the paracervical infiltration group (mean: 4.22 ± 1.73, median: 5). Tolerance to pain, assessed by the medical staff using qualitative variables, was bad for the control group, very good for the nitrous oxide group, and good for the paracervical infiltration group (p < .05). There were no complications in 82% of the patients in the nitrous oxide group, whereas in the paracervical infiltration group, there were complications in more than 50% of the patients. No severe complications occurred.ConclusionNitrous oxide is a safe and effective analgesic technique for polipectomy office hysteroscopy compared with the paracervical infiltration and control groups.Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

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