The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization

Abstract

Uterine artery embolization (UAE) is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.

The effects of single‐dose dexamethasone on inflammatory response and pain after uterine artery embolisation for symptomatic fibroids or adenomyosis: a randomised controlled study

“…Pain is thought to be related to the induced inflammatory processes secondary to the ischaemic changes of fibroids and uterine tissue caused by bilateral occlusion of uterine arteries . Different protocols have been used to control pain, and NSAIDs are most commonly used as an adjunct to opioid IV PCA for the anti‐inflammatory and analgesic effects . Even the short‐term use of NSAIDs can cause dyspepsia or acute kidney injury, however, and thus caution should be taken when using NSAIDs …”

“…5,8 Different protocols have been used to control pain, and NSAIDs are most commonly used as an adjunct to opioid IV PCA for the antiinflammatory and analgesic effects. 3,[19][20][21] Even the shortterm use of NSAIDs can cause dyspepsia or acute kidney injury, however, and thus caution should be taken when using NSAIDs. 22,23 Glucocorticoids exhibit superior anti-inflammatory efficacy compared with NSAIDs because it inhibits both the vascular (vasodilation and increased vessel wall permeability) and cellular (leukocyte extravasation and phagocytosis) phases of inflammation, whereas NSAIDs inhibit only the vascular phase.…”

A new horizon in the prevention of the postembolization syndrome after transcatheter arterial chemoembolization for hepatocellular carcinoma

“…PES is also observed after either TACE with drug‐eluting beads, with rates of 25%‐42% for grade 2 PES, or after radioembolization with Yttrium90, with a metanalysis showing an overall occurrence rate of 18%‐20%, regardless of whether glass or resin embolizing beads were used . Symptoms of PES (nausea, fever, and malaise/asthenia) are not specific to TACE, but rather represent a generalized event reported to occur after embolization of other abdominal organs, such as the spleen, kidney, uterus, which only differ in terms of location of the pain. PES is, in fact, reported to be caused by the release of inflammatory cytokines in the bloodstream .…”

“…A small randomized trial testing the addition of local anesthetics to the embolizing mixture showed only the reduction of painkiller drugs in the next few days, but not a reduction in the occurrence of PES . Prophylactic use of nonsteroidal antinflammatory drugs has been adopted in some centers to prevent PES after uterine embolization, but clearly these drugs are contraindicated in patients who have cirrhosis and HCC. It seems, therefore, that PES is an unavoidable consequence of TACE that is to be tolerated for the major benefit of prolonged survival.…”

Managing Postembolization Syndrome–Related Pain after Uterine Fibroid Embolization

“…They hypothesized that continued use of anti-inflammatory drugs like naproxen after discharge is essential for the prevention of pain the first night after UAE. 14,22 Discontinuation led to some readmissions due to pain. Although the authors were able to demonstrate an effective regimen for overall pain control, the complex list and timing of different drugs made it hard to achieve successful pain control in all patients.…”