Clinical and Periprocedural Pain Management for Uterine Artery Embolization

Abstract

Uterine artery embolization has Level A data supporting excellent safety and efficacy in treating symptomatic uterine leiomyomata. However, there is a perception that either postprocedural pain is severe or poorly managed by the physician performing these procedures. This has led some primary care physicians to omit this procedure from the patients' options or to steer patients away from this procedure. A few simple techniques (pruning of the vascular tree and embolizing to 5?10 beat stasis) and fastidious pre-, intra-, and post-procedural management can nearly eliminate significant pain associated with embolization. Specifically, early implementation of long-acting low-dose narcotics, antiemetics and anti-inflammatory medications is critical. Finally, the use of a superior hypogastric nerve block, which takes minutes to perform and carries a very low risk, significantly reduces pain and diminishes the need for narcotics; when this technique was used in a prospective study, all patients were able to be discharged the day of the procedure. In the authors' experience, patients treated in this manner largely recover completely within 5 days and have a far less traumatic experience than patients traditionally treated with only midazolam (Versed) and fentanyl citrate (fentanyl) intraprocedurally, and narcotics and nonsteroidal antiinflammatory drugs postprocedurally.

Postprocedure intravenous patient-controlled analgesia compared to epidural patient-controlled analgesia use after uterine fibroid embolization: A clinical audit

“…PES is thought to be secondary to infarction of all or a portion of the fibroids. [3] Patients usually experience pain, nausea and vomiting, fever, fatigue, and malaise. The symptoms of PES follow a typical pattern after UFE with pelvic pain and cramping worsening the first 2–3 h, reaching a constant level for 8–12 h likely from transient myometrial ischemia.…”

“…The symptoms of PES follow a typical pattern after UFE with pelvic pain and cramping worsening the first 2–3 h, reaching a constant level for 8–12 h likely from transient myometrial ischemia. [3] After this, the pain usually subsides to a significantly lower level. [3] There are multiple regimens that have been used for pain control after UFE.…”

“…[3] After this, the pain usually subsides to a significantly lower level. [3] There are multiple regimens that have been used for pain control after UFE. At this institution, epidural analgesia has become the standard practice supported by anesthesia availability and patient's overall satisfaction with their pain control.…”

“…This method of pain control when combined with NSAIDS has been shown to improve patient satisfaction by providing adequate pain control after UFE. [3] However, lack of familiarity among interventionalists and potential associated risks of percutaneous SHNB, including but not limited to bowel transgression make it less appealing as compared with the well validated technique of epidural analgesia or i.v. PCA.…”

Intra-arterial anaesthetics for pain control in arterial embolisation procedures: a systematic review and meta-analysis

“…Arterial embolisation is currently best practice for a variety of disease processes with expanding and increasingly novel indications. However, embolisation procedures can often be complicated by significant post-operative pain due to the ischaemia and subsequent inflammation they induce in downstream tissues (Spencer et al 2013).…”