Environmental Visual Distraction With Nitrous Oxide During Outpatient Hysteroscopy: A Randomized Pilot Study

This document describes the protocol of a pilot randomized clinical study evaluating the effect of environmental visual distraction combined with nitrous oxide (N₂O) analgesia on the procedural experience of patients undergoing outpatient operative hysteroscopy at the Hysteroscopy Unit of ASL Biella. Office hysteroscopy is widely used for the diagnosis and treatment of intrauterine conditions such as abnormal uterine bleeding, infertility, and endocavitary pathology. Thanks to technological advances and the miniaturization of instruments, many procedures can now be performed in an outpatient setting without general anesthesia. However, pain perception and procedural anxiety may limit patient tolerance and the completion of the examination. Nitrous oxide is commonly used for analgesia in outpatient hysteroscopy due to its rapid onset, reversibility, and favorable safety profile. It allo