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Semin intervent Radiol 2013; 30(04): 354-363
DOI: 10.1055/s-0033-1359729
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical and Periprocedural Pain Management for Uterine Artery Embolization

Elizabeth Brooke Spencer
1   RIA Endovascular, Greenwood Village, Colorado
,
Peter Stratil
1   RIA Endovascular, Greenwood Village, Colorado
,
Heidi Mizones
1   RIA Endovascular, Greenwood Village, Colorado
› Author Affiliations
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Publication History

Publication Date:
20 November 2013 (online)

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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.

Keywords

uterine fibroid embolization - UAE - pain - superior hypogastric nerve block - postembolization syndrome - interventional radiology
 

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