Sodium Bicarbonate-Based Warm Saline Versus Warm Saline for Peritoneal Irrigation in Diagnostic Hysteroscopy-Laparoscopy: A Prospective Randomized Controlled Trial

ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice.     ABSTRACT Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, sub-diaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients’ demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group. Conclusion: Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopy-laparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients’ recovery and experience towards operative practice. Keywords: Laparoscopy, Pain, VAS, Sodium bicarbonate, PONV.