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DOI: 10.1055/s-0041-1731406
Managing Postembolization Syndrome–Related Pain after Uterine Fibroid Embolization
Uterine fibroids are the most common neoplasm affecting women, occurring in more than 70% of women prior to menopause. Of that 70%, 25% have symptoms severe enough to warrant treatment.[1] Symptoms range from abnormal uterine bleeding, bulk symptoms with urinary and bowel incontinence, dyspareunia, infertility, and debilitating chronic pain.[2]
Since its introduction in 1995, uterine artery embolization (UAE) has evolved into a well-established, safe, and effective minimally invasive, uterine-sparing procedure for the treatment of symptomatic uterine fibroids.[3] [4] [5] Annually, greater than 25,000 UAE procedures are performed worldwide.[6] Despite its successes, a persistent challenge and impediment to more widespread use of UAE has been management of postprocedure pain as a result of postembolization syndrome (PES). Inadequate pain control is the most common indication for admission and readmission.[7] Predicting the degree of PES is challenging. The range of severity may vary based on intrinsic patient factors, fibroid size and location, imaging characteristics, or preprocedural symptoms.[8] New techniques and pain regimens can be applied to manage symptoms and significantly improve patient satisfaction.
The objective of this review is to discuss pain management options after UAE by summarizing the current available literature.
Publication History
Article published online:
10 August 2021
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References
- 1 Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124 (10) 1501-1512
- 2 Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12 (01) 6
- 3 Lampmann LE, Lohle PN, Smeets A. et al. Pain management during uterine artery embolization for symptomatic uterine fibroids. Cardiovasc Intervent Radiol 2007; 30 (04) 809-811
- 4 Ravina JH, Herbreteau D, Ciraru-Vigneron N. et al. Arterial embolisation to treat uterine myomata. Lancet 1995; 346 (8976): 671-672
- 5 American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol 2008; 112 (2, Pt 1): 387-400
- 6 Keung JJ, Spies JB, Caridi TM. Uterine artery embolization: a review of current concepts. Best Pract Res Clin Obstet Gynaecol 2018; 46: 66-73
- 7 Hovsepian DM, Mandava A, Pilgram TK. et al. Comparison of adjunctive use of rofecoxib versus ibuprofen in the management of postoperative pain after uterine artery embolization. J Vasc Interv Radiol 2006; 17 (04) 665-670
- 8 Roth AR, Spies JB, Walsh SM, Wood BJ, Gomez-Jorge J, Levy EB. Pain after uterine artery embolization for leiomyomata: can its severity be predicted and does severity predict outcome?. J Vasc Interv Radiol 2000; 11 (08) 1047-1052
- 9 Hovsepian DM, Siskin GP, Bonn J. et al; CIRSE Committee, SIR Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 2004; 15 (06) 535-541
- 10 Ganguli S, Faintuch S, Salazar GM, Rabkin DJ. Postembolization syndrome: changes in white blood cell counts immediately after uterine artery embolization. J Vasc Interv Radiol 2008; 19 (03) 443-445
- 11 Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol 2013; 30 (04) 354-363
- 12 Pasero C, Stannard D. The role of intravenous acetaminophen in acute pain management: a case-illustrated review. Pain Manag Nurs 2012; 13 (02) 107-124
- 13 Chaabane S, Hoffman C, Kim G. et al. A prospective, double-blind, randomized controlled study evaluating the effects of two new IV medications, IV acetaminophen and/or IV ibuprofen, on standard of care pain and antiemetic management in uterine fibroid embolization patients. J Vasc Interv Radiol 2017; 28 (02) S47-S48
- 14 Bilhim T, Pisco JM. The role of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of the post-embolization symptoms after uterine artery embolization. Pharmaceuticals (Basel) 2010; 3 (06) 1729-1738
- 15 Siskin GP, Stainken BF, Dowling K, Meo P, Ahn J, Dolen EG. Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients. J Vasc Interv Radiol 2000; 11 (03) 305-311
- 16 Hansen RN, Pham AT, Boing EA, Lovelace B, Wan GJ, Urman RD. Reduced length of stay and hospitalization costs among inpatient hysterectomy patients with postoperative pain management including IV versus oral acetaminophen. PLoS One 2018; 13 (09) e0203746-e0203746
- 17 Mahajan L, Mittal V, Gupta R, Chhabra H, Vidhan J, Kaur A. Study to compare the effect of oral, rectal, and intravenous infusion of paracetamol for postoperative analgesia in women undergoing cesarean section under spinal anesthesia. Anesth Essays Res 2017; 11 (03) 594-598
- 18 Johnson RJ, Nguyen DK, Acosta JM, O'Brien AL, Doyle PD, Medina-Rivera G. Intravenous versus oral acetaminophen in ambulatory surgical center laparoscopic cholecystectomies: a retrospective analysis. P&T 2019; 44 (06) 359-363
- 19 Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther 2001; 26 (04) 257-264
- 20 Bresalier RS, Sandler RS, Quan H. et al; Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial Investigators. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005; 352 (11) 1092-1102
- 21 Nissen SE, Yeomans ND, Solomon DH. et al; PRECISION Trial Investigators. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med 2016; 375 (26) 2519-2529
- 22 Pisco JM, Bilhim T, Duarte M, Santos D. Management of uterine artery embolization for fibroids as an outpatient procedure. J Vasc Interv Radiol 2009; 20 (06) 730-735
- 23 Freire GMG, Cavalcante RN, Motta-Leal-Filho JM. et al. Controlled-release oxycodone improves pain management after uterine artery embolisation for symptomatic fibroids. Clin Radiol 2017; 72 (05) 428.e1-428.e5
- 24 Saibudeen A, Makris GC, Elzein A. et al. Pain management protocols during uterine fibroid embolisation: a systematic review of the evidence. Cardiovasc Intervent Radiol 2019; 42 (12) 1663-1677
- 25 Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2013; 110 (02) 191-200
- 26 Wang M, Kohi MP. The rationale, design, and methods of a randomized, controlled trial to evaluate the efficacy of single-dose dexamethasone in reducing post-embolization syndrome in patients undergoing uterine artery embolization. Contemp Clin Trials Commun 2018; 12: 85-89
- 27 Kim SY, Chang CH, Lee JS, Kim YJ, Kim MD, Han DW. Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis: a prospective, randomized study. J Vasc Interv Radiol 2013; 24 (06) 779-786
- 28 Raldi FV, Nascimento RD, Sato FRL, Santos LM, Amorim JBO, de Moraes MB. Evaluation of the impact of preoperative use of dexamethasone and cyclobenzaprine in surgical extraction of lower third molars on trismus by electromyographic analysis. Oral Maxillofac Surg 2019; 23 (04) 395-405
- 29 Hwang SK. Advances in the treatment of chronic pelvic pain: a multidisciplinary approach to treatment. Mo Med 2017; 114 (01) 47-51
- 30 Rasuli P, Jolly EE, Hammond I. et al. Superior hypogastric nerve block for pain control in outpatient uterine artery embolization. J Vasc Interv Radiol 2004; 15 (12) 1423-1429
- 31 Park PJ, Kokabi N, Nadendla P, Lindsey T, Dariushnia SR. Efficacy of intraprocedural superior hypogastric nerve block in reduction of postuterine artery embolization narcotic analgesia use. Can Assoc Radiol J 2020; 71 (01) 75-80
- 32 Pereira K, Morel-Ovalle LM, Wiemken TL. et al. Intraprocedural superior hypogastric nerve block allows same-day discharge following uterine artery embolization. J Vasc Interv Radiol 2020; 31 (03) 388-392
- 33 Stewart JK, Patetta MA, Burke CT. Superior hypogastric nerve block for pain control after uterine artery embolization: effect of addition of steroids on analgesia. J Vasc Interv Radiol 2020; 31 (06) 1005-1009.e1
- 34 Hoffman C, Yarosh C, Boyd E. et al. Superior hypogastric nerve block in uterine fibroid embolization patients with radial artery access: vascular considerations, anesthetic choices, and rescue options. J Vasc Interv Radiol 2018; 29 (05) 745-747
- 35 Noel-Lamy M, Tan KT, Simons ME, Sniderman KW, Mironov O, Rajan DK. Intraarterial lidocaine for pain control in uterine artery embolization: a prospective, randomized study. J Vasc Interv Radiol 2017; 28 (01) 16-22
- 36 Duvnjak S, Andersen PE. Intra-arterial lidocaine administration during uterine fibroid embolization to reduce the immediate postoperative pain: a prospective randomized study. CVIR Endovasc 2020; 3 (01) 10
- 37 Katsumori T, Miura H, Yoshikawa T, Seri S, Kotera Y, Asato A. Intra-arterial lidocaine administration for anesthesia after uterine artery embolization with trisacryl gelatin microspheres for leiomyoma. J Vasc Interv Radiol 2020; 31 (01) 114-120
- 38 Caridi T. Intra-arterial lidocaine is not found to be effective for reducing pain after uterine fibroid embolization in a retrospective study: now what?. J Vasc Interv Radiol 2020; 31 (01) 121-122
- 39 Keyoung JA, Levy EB, Roth AR, Gomez-Jorge J, Chang TC, Spies JB. Intraarterial lidocaine for pain control after uterine artery embolization for leiomyomata. J Vasc Interv Radiol 2001; 12 (09) 1065-1069
- 40 Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol 2014; 25 (03) 443-447
- 41 Nakhaei M, Mojtahedi A, Faintuch S, Sarwar A, Brook OR. Transradial and transfemoral uterine fibroid embolization comparative study: technical and clinical outcomes. J Vasc Interv Radiol 2020; 31 (01) 123-129
- 42 Liu LB, Cedillo MA, Bishay V. et al. Patient experience and preference in transradial versus transfemoral access during transarterial radioembolization: a randomized single-center trial. J Vasc Interv Radiol 2019; 30 (03) 414-420
- 43 Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol 2015; 18 (02) 58-65