***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 AIM To evaluate the effectiveness of a rectal nonsteroidal anti-inflammatory drug ( indomethacin ) for pain relief during a hysterosalpingography ( HSG ) . MATERIAL S AND METHODS This prospect i ve , r and omized study included 82 women divided r and omly into two groups . The study group received self-administered rectal indomethacin , while the control group received a placebo before the procedure .  Degrees of pain were evaluated using the visual analog scale ( VAS ) at four different steps during the procedure and 30 min afterwards . The anxiety-depression status of the patients was evaluated using a vali date d Turkish version of the Beck anxiety-depression form before the procedure . RESULTS There were no statistically significant differences in the demographic characteristics of patients .  The mean pain scores during tenaculum application ( step 2 ) , cervical traction ( step 3 ) , contrast injection ( step 4 ) and 30 min after the procedure , were significantly lower in the study than the control group ( P < 0.05 ) . Step 4 was the most painful in both groups ( VAS scores 3.2 ± 0.6 study vs. 5.3 ± 1.1 control ) . The mean pain score in step 4 for patients with abnormal HSG results was significantly higher than in patients with normal HSG results ( P < 0.05 ) . The mean anxiety and depression scores immediately before the procedure were not statistically different between the groups ( P = 0.610 and P = 0.129 , respectively ) . CONCLUSION Our study demonstrated a significant reduction in pain in patients who received a single rectal dose of indomethacin ; therefore , we recommend the use of rectal indomethacin for reducing pain during a HSG procedure 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 Background : Hysterosalpingography ( HSG ) is considered as a primary test in infertility work up worldwide due to its reliability in evaluating abnormalities related to the uterus and fallopian tubes . Objectives : To assess the efficacy of applying eutectic mixture of local anesthetics ( lidocaine-prilocaine cream ) ( EMLA ) on the uterine cervix in reducing pain during HSG . Patients and Methods : Eighty patients undergoing HSG as part of infertility evaluation were r and omly allocated to groups receiving either EMLA ( N = 40 ) or placebo cream ( N = 40 ) in a double-blinded prospect i ve study . Fifteen minutes before HSG , 5 grams of 5 % cream was applied to the uterine cervix using a cervical applicator . The degree of pain experienced by the patient was evaluated during and after HSG at five predefined steps on a visual analogue scale ( VAS ) . Results : There was no significant difference in the efficacy between EMLA and placebo creams in pain perception during the entire procedure . There was no significant difference in long term pain perception half an hour after the HSG performance . Conclusions : This study does not support the use of EMLA for HSG Purpose Hysterosalpingography ( HSG ) is an important tool for evaluation of tubal factors  in infertility . It does not require anesthesia but can be a painful procedure . Thus , this study was undertaken to establish the role of intracervical block as pain relief modality for HSG . Methods This prospect i ve , r and omized study included hundred women attending the Department of Obstetrics and Gynecology , at a tertiary care centre in India . They were divided r and omly through a computer generated table into two groups of 50 women each . In the study group , women received intracervical block along with premedication whereas in the control group women received premedication alone . Each patient was asked to rate her pain at six different points of time ( T1–T6 ) during HSG using Visual analogue scale ( VAS ) and Verbal descriptive score . The difference in pain scores amongst the two groups was analyzed using independent t test . Results Reduction of pain was observed from placement of tenaculum till end of procedure ( T3–T6 ) with intracervical block ( p < 0.05 ) . Pain remained at a statistically lower level during the most painful steps i.e. traction of the cervix ( VAS : 2.080.49 cm , 95 % C I 1.18–2.98 vs. 4.21.15 cm , 95 % CI 3.3–5.1 , p = 0.001 ) and with the insertion of dye ( VAS : 2.640.49 , 95 % CI 1.7–3.5 vs. 5.121.45 . 95 % CI 4.3–6.0 , p = 0.001 ) in the study group as compared to control group . Conclusion Intracervical block can be offered to all women undergoing HSG  to make the procedure less painful and thus improve the compliance Summary The aim of this study was to compare the efficacy of equivalent doses of lignocaine spray vs lignocaine jelly in reducing pain during the application of a tenaculum to the cervix . A total of 58 women undergoing hysterosalpingography were prospect ively r and omised to receive either two doses of 10 % lignocaine spray or 1 ml of 2 % lignocaine jelly ( both doses equivalent to 20 mg of lignocaine base ) topically onto the cervix before tenaculum attachment . There was no difference in pain scores ( measured by visual analogue scale and 4-point verbal descriptor scale ) between lignocaine spray and lignocaine jelly during the attachment of the tenaculum to the cervix . In conclusion , there was no difference in pain during tenaculum attachment to the cervix following topical application of equivalent doses of either lignocaine jelly or spray 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 OBJECTIVE : A hysterosalpingogram is an integral part of the evaluation of infertility but is often painful . Intrauterine anesthesia may help to alleviate the discomfort associated with this procedure . METHODS : We conducted a r and omized , double-blinded , placebo-controlled trial of intrauterine lidocaine in women undergoing hysterosalpingography ( HSG ) . All women were instructed to take a nonsteroidal analgesic before the hysterosalpingogram . Patients received 3 mL of buffered 2 % lidocaine solution or 0.9 % normal saline instilled into the uterus before HSG . The primary outcome was the degree of pain experienced documented via 10-cm visual analogue pain scales . Systematic assessment s of discomfort were also collected by the attending physician , radiology technician , and radiology physician . RESULTS : Sixty-four patients were r and omly assigned to placebo  and 63 women were r and omly assigned to the lidocaine group . There were no differences in mean age , race , parity , or history of dysmenorrhea or chronic pelvic pain . There were no differences in the pain scores at baseline , during , or after the study procedure between the 2 groups . Peak pain scale scores associated with the procedure were 5.3 ± 0.4 in both the placebo and study groups . In addition , assessment s of patient discomfort revealed no significant differences between 
    Output:
    
IOA got excess but not statistically significant lower visual analogue score ( VAS ) pain score during HSG or more than 30 minutes after HSG compared with the other groups .
OOA result ed in excess but not statistically significant higher VAS pain score during HSG compared with the other groups except placebo group .
CONCLUSION This new Bayesian data network meta- analysis from r and omized controlled trials demonstrated that IOA result ed in the highest probability to reduce the pain during HSG or at 30 minutes or more after HSG among the six interventions considered