***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To evaluate the effectiveness of paracetamol as a prophylactic analgesic for hysterosalpingography ( HSG ) . DESIGN A prospect i ve double blind r and omized controlled trial comparing one 1 g of paracetamol ( SmithKline Beecham , Brentford , U.K. ) to placebo taken 30 min before HSG . One hundred consecutive out- patients were studied prospect ively . The analgesic effectiveness during the procedure and at 24 h and 1 week post procedure was analysed by a postal pain score question naire . Additional data on the ethnicity of the patient , sex and level of experience of the radiologist performing the hysterosalpingogram , the parity of the patient , the ease of the procedure , and whether pathology was identified were also recorded . RESULTS Eighty-eight patients ( 88 % ) replied , 39 ( 44 % ) received  paracetamol  and 49 placebo ( 56 % ) . During the procedure 3/39 ( 7 % ) of women in the paracetamol group were pain-free compared to 9/49 ( 18 % ) in the placebo group , which was not significant ( P = 0.11 ) . At 24 h , 15/39 ( 38 % ) of women in the paracetamol group were pain-free compared to 20/49 ( 41 % ) in the placebo group , which was not significant ( P = 0.82 ) . At 1 week , 27/39 ( 69 % ) of women in the paracetamol group were pain-free compared to 29/49 ( 59 % ) in the placebo group , which was not significant ( P = 0.33 ) . No significant difference in mean pain scores was determined during the procedure ( P = 0.91 ) , or at 24 h post procedure ( P = 0.94 ) . Similarly , no difference in mean pain scores was identified with regard to the ethnicity of the patient , the sex of the radiologist performing the procedure , the level of experience of the radiologist performing the procedure , or whether pathology was present or not . Difficult cannulations were associated with higher mean pain scores , however , there was no difference in mean pain scores between the paracetamol or placebo groups for both easy and difficult cannulations . CONCLUSION Paracetamol is not effective as a prophylactic analgesic for HSG . If a prophylactic analgesic is considered necessary for pain relief during HSG we recommend that a non-steroidal anti-inflammatory drug ( NSAID ) is used Background / Aims : A hysterosalpingogram is an integral part of the evaluation of infertility , however , it is often painful . Methods : We conducted a r and omized double-blinded , placebo-controlled trial of intravenous infusion of remifentanil in women undergoing hysterosalpingography ( HSG ) . We r and omly allocated 62 patients scheduled for HSG to receive either a continuous infusion of 0.25 µg·kg–1 of remifentanil or placebo .  The degree of pain was documented via 10-cm visual analog scales ( VAS ) . Patients ’ discomfort , side effects and recovery times were also recorded . Results : The VAS scores during HSG were 1.25 ± 1.31 in the remifentanil group and 4.78 ± 1.7 in the placebo group ( p < 0.001 ) . There were more patients in the remifentanil group that rated their condition as excellent ( p < 0.001 ) . The groups did not differ with regard to the incidence of side effects . The recovery times were found statistically longer in the remifentanil group ( 14 ± 5 vs. 10 ± 3 min ) . All the patients were discharged 30 min after the procedures without any side effects . Conclusion : Remifentanil infusion during HSG is superior to placebo for relief of pain with minimal opioid side effects OBJECTIVE To assess whether transcervical intrauterine topical instillation of a local anesthetic agent reduces  pain at hysterosalpingography . DESIGN Prospect i ve , r and omized , double-blind , placebo-controlled study . SETTING Department of reproductive medicine at a university teaching hospital . PATIENT(S ) One hundred ten women undergoing hysterosalpingography ( HSG ) . INTERVENTION(S ) Subjects were r and omized to receive either 2 mL of 2 % plain lignocaine or 2 mL of 0.9 % sodium chloride solution ( placebo ) topically into the uterine cavity before the HSG was performed . MAIN OUTCOME MEASURE(S ) The degree of lower abdominal pain experienced both during the injection of contrast media at HSG and 10 minutes after the procedure using a 20-cm visual analogue scale ( VAS ) and a four-point verbal descriptor scale ( VDS ) . RESULT ( S ) There was no difference in pain scores between lignocaine and placebo during the HSG . However , at 10 minutes after the HSG , subjects receiving lignocaine experienced more pain than those on placebo . CONCLUSION ( S ) Transcervical intrauterine topical instillation of 2 mL of 2 % plain lignocaine does not reduce pain during HSG and may lead to increased pain immediately after the procedure BACKGROUND The aim of our study is to evaluate the efficacy of applying lidocaine 25 mg-prilocaine-25 mg/G cream ( EMLA 5 % ) on the uterine cervix for pain relief when performing hysterosalpingography ( HSG ) . METHODS Eighty-two patients undergoing HSG as part of infertility evaluation were r and omized into groups receiving EMLA ( 42 ) or placebo cream ( 40 ) in a double-blinded prospect i ve study from which four women were later excluded . The cream was applied to the uterine cervix by means of a cervical cup 30 min before the HSG . Pain perception related to the HSG procedure was scored by visual analogue scale ( VAS ) at five predefined steps : after speculum application , after cervical instrumentation of the tenaculum and cannula , at the end of uterine filling , at completion of tubal spillage , and immediately following instrument removal . In addition , the patients were asked to retrospectively rate the pain during the entire procedure in a telephone interview the following day . RESULTS Cervical instrumentation was found to be the most painful step of HSG ( P < 0.001 ) . When comparing the VAS pain scores , cervical instrumentation in the EMLA-treated patients was associated with significantly less pain than the control group : 3.3 + /- 2.9 versus 4.9 + /- 2.7 , respectively ( P = 0.02 ) . CONCLUSIONS Topical application of EMLA 5 % cream on the uterine cervix before performing HSG significantly reduced the pain during this procedure OBJECTIVES To compare the efficacy of oral naproxen with intrauterine instillation of 1 % lignocaine for pain relief in women undergoing hysterosalpingography ( HSG ) as an infertility investigation . METHODS One hundred women undergoing HSG were r and omly allocated into 2 groups . Group A ( n = 50 ) underwent intrauterine instillation of 5 mL of 1 % lignocaine 2 minutes prior to the procedure , while the women in group B ( n = 50 ) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG . Pain scores immediately after the procedure ( 0 minutes ) and delayed pain scores ( 30 minutes ) were recorded and compared . RESULTS Women in both groups were comparable in age and parity . The mean + /- SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different ( P = 0.12 and P = 0.07 ) . CONCLUSION Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG OBJECTIVE : To estimate whether an intracervical block of 1 % lidocaine decreased pain perception compared with placebo during the performance of a hysterosalpingogram . METHODS : A r and omized controlled trial was conducted with 120 patients assessing pain perception during a hysterosalpingogram . Patients were r and omly assigned to one of three groups . Patients received either a 1 % lidocaine intracervical block , an intracervical saline injection , or no injection .  Visual analog ( VAS ) and qualitative scales were used to assess study participants ' pain at six different time points during the hysterosalpingogram . RESULTS : Subjects receiving the lidocaine block had significantly less pain ( P<.001 ) by VAS during tenaculum placement ( approximately 61 % less , 1.303 cm ) and with tenaculum traction ( approximately 40 % less , 2.804 cm ) compared with both the intracervical saline injection group and the no injection group ( tenaculum placement , 3.384 cm and 3.354 cm , and tenaculum traction , 4.705 cm and 4.961 cm , respectively ) . There was no improvement seen with pain perception during instillation of the contrast in the lidocaine group compared with the saline or no injection group ( P<.073 ) . Subjects who received the saline injection had statistically more pain ( P<.001 ) by VAS ( 2.647 cm ) immediately after the injection compared with the lidocaine ( approximately 79 % greater , 1.476 cm ) and no injection groups ( 115 % greater , 1.232 cm ) . CONCLUSION : Lidocaine intracervical block provides better pain relief than placebo during tenaculum placement and tenaculum traction during a hysterosalpingogram . This study suggests that patients should be offered an intracervical block before placement of the cervical tenaculum to decrease pain during the performance of a hysterosalpingogram . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00372658 LEVEL OF EVIDENCE : There is an increasing tendency to perform minor gynecological procedure on an outpatient setting in which adequate pain management is m and atory in order to maximize the success of procedure . Topical anesthetics have been extensively studied in many minor gynecological procedures and shown to provide good pain relief especially for procedures involving the surface tissues ; however they have hardly been explored as means of reducing pain for hysterosalpingography ( HSG ) . We aim ed to investigate whether intrauterine lidocaine gel application can provide any pain relief during and after HSG . ( excerpt OBJECTIVE To compare the analgetic efficacy and side-effects of Naproxen and Tramadol following the outpatient VABRA aspiration or hysterosalpingography . SETTING Ninety-one patients from the gynaecology clinics of two university hospitals and one municipal-teaching hospital . DESIGN Multicentre double blind r and omized clinical trial . Computerised r and omisation , stratification per-centre . METHODS Semiquantitative assessment of the two drugs was performed by the patient and the gynaecologist using a 1- to 6-point scale . Pain , stress and well-being was scored by the patient using the visual analog scale ( VAS ) and the verbal description scale ( VDS ) , ranging from 0 ( good ) to 100 ( bad ) . Side-effects during the first 24 h postoperatively were recorded by the patient in a diary . RESULTS The analgetic efficacy ( pain , stress and well-being ) of Naproxen and Tramadol was identical . Subjective assessment by the patient and the doctor also revealed no differences between Naproxen and Tramadol .  Side-effects of Tramadol , however , were significantly more severe than those of Naproxen and this phenomenon was responsible for a lower ability to proceed with normal activities in the Tramadol group . CONCLUSION Tramadol is a good alternative for Naproxen at outpatient VABRA or HSG procedures when Naproxen is contra-indicated Objective To determine the efficacy of intrauterine lidocaine for decreasing pain associated with endometrial biopsy using the Pipelle instrument ( Unimar ; Wilton , CT ) . Methods Forty-one premenopausal and postmenopausal women had 5 mL of either 2 % lidocaine or saline instilled in their uteri before endometrial biopsies . Subsequently , each woman completed a 20-cm visual analogue scale for subjective pain experience . We compared histologic findings in endometrial specimens . Results Before the study , analysis of specimens ( n = 6 ) found no histologic effect on ability to interpret endometrial biopsies by pathologists who were masked to lidocaine or saline . There was no statistically significant difference in age , parity , race , history of chronic pelvic pain , menopausal status , use of tenaculum , or prior endometrial biopsy . The procedure was easy , with no clinical ly significant side effects . On the visual pain scale , the median ( range ) score for the lidocaine group ( 4.7 , 0–19.7 ) compared with the placebo group ( 9.9 , 1.6–20 ) showed significant reduction in pain corresponding with a decrease from moderate to mild ( P < .01 ) . Conclusion Intrauterine lidocaine is simple and effective for decreasing pain associated with the Pipelle endometrial biopsy AIM The aim of this study was to evaluate whether the use of lidocaine 10 % spray was effective in pain control during hysterosalpingography ( HSG ) . METHODS A total of 81 patients were r and omly assigned to three groups : Group 1 , 10 mg lidocaine hydrochloride 10 % spray ; Group 2 , 20 mg lidocaine hydrochloride 10 % 
    Output:
    
There is little evidence of benefit in terms of pain relief of any of the interventions considered in this study during or immediately after HSG .
However , there is limited evidence of pain reduction 30 minutes after the procedure .