Effective pain management during oocyte retrieval improves patient comfort and clinic efficiency

At the ACE meeting 2013, Jessop Fertility in Sheffield (UK), presented results from two studies¹ resulting in the implementation of a new protocol, reducing the cost and improving the patient’s well-being during and after the oocyte retrieval procedure.
The increase in efficiency was made possible by reducing the Fentanyl dose administered due to the introduction of the Sense™ needle, a thinner oocyte retrieval needle. The aim of the studies were to evaluate the possibilities to introduce more effective pain management, reduce the total time for the oocyte retrieval procedure and reduce the pain experienced by the patients.

Successful oocyte retrieval procedure

A successful oocyte retrieval needs to be fast, precise and retrieve the maximal amount of undamaged oocytes without complications for the patient. One of the advantages of ultrasound guided oocyte retrieval technique is that it can be performed under local anaesthesia. Owing to the fact that patients may experience pain during the procedure, many clinics still use general anaesthesia despite the oocyte retrieval procedure then becoming more complicated, expensive and involves more risks for the patients. A previous published article² shows that the use of a thinner oocyte retrieval needles significantly reduces the pain experienced by the patient.

Minimising patient pain experience

The results of the first study in 2009 (n=51) at Jessop Fertility showed a correlation between the pain experienced by the patients, time of the procedure and needle type used (i.e. single or double lumen needle). With longer time for the oocyte retrieval procedure, the experience of pain increased and more Fentanyl had to be administered. Over 50% of the patients experienced moderate to severe pain. In order to decrease the pain experienced by the patients the clinic changed the protocol to include IV Paracetamol prior to the oocyte retrieval procedure and introduced the use of a smaller size needle i.e. single lumen needles in preference to the double lumen needles.

Improved efficiency

In the follow-up study, conducted in 2012 (n=100), the pain experienced by the patients and the dose of Fentanyl administered, time of the procedure and needle type were evaluated including the new protocol. Besides the conventional single and double lumen needles, the Sense needle (single lumen needle) from Vitrolife was included. The result of the study showed that the tapered design of the Sense needle significantly reduced the pain experienced by the patient (Figure 1) which resulted in a reduced mean Fentanyl dose used per patient (Figure 2).

Figure 1

Figure 2

Fig 2_Senseabstract.png

The Fentanyl dose administered was also significantly reduced for procedures shorter than 15 minutes (Figure 3) and for the patients given IV Paracetamol prior to the oocyte retrieval (Figure 4).

Figure 3

Fig 3_Senseabstract.png

Figure 4

Conclusion

The clinic concluded that improved efficiency had been achieved by faster discharge of the patient due to lower Fentanyl consumption and reduced treatment length. Other benefits were reduced pain and anxiety for the patients.

1. Chester, et al., Improving the patient’s experience of pain during egg collection. 2012. 2. Wikland, M., et al., Pain experience during oocyte aspiration: comparison between a newly designed reduced needle and a standard needle. Human Reproduction, 2010. 25(25, supplement 1): p.O-226.

Optimise oocyte retrieval performance and improve patient comfort with Sense, a needle that causes minimal tissue damage

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