Intra-arterial lidocaine administration during uterine fibroid embolization to reduce the immediate postoperative pain: a prospective randomized study

Abstract

Background: To investigate if intra-arterial lidocaine administrated immediately after the embolisation endpoint reduces the pain. Methods: Forty patients were randomised and 36 completed the study for purposes of analysis. In one group, the patients got 1% 10 ml lidocaine (100 mg) administered into each uterine artery immediately after embolisation with microspheres. The other group was embolised without supplementary lidocaine. The patients scored their pain on a visual analogue scale (VAS) 2 h, 4 h, 7 h, 10 h and 24 h after embolisation, and the total amount of used morphine was noted. Three-month follow-up MRI control was scheduled for all the patients to investigate the infarction rate. Results: Embolisation was performed without any complications and with embolisation of both uterine arteries in all cases. Intra-arterial lidocaine was administered in all 20 patients without complications, and 20 patients in a control group did not receive lidocaine intra-arterial. VAS schemes showed a significant reduction in pain experience 2 h after UFE where mean pain score in the lidocaine group was 42.7 ± 21.4 compared with the control group in which the mean pain score was 61.1 ± 20.4 (p < 0.02). There was no significant difference in pain score 4 h, 7 h, 10 h and 24 h after UFE. In the lidocaine group, the mean amount of used morphine was significantly less with 11.2 mg compared with 20.2 mg in the control group (p < 0.03). Three months of MR follow-up control showed no significant difference in the grade of fibroid infarction. Conclusion: Intra-arterial Lidocaine administration after embolisation is safe and effective in reducing postprocedural pain in the early hours and opioid usage in the first 24 h following UAE.

Managing Postembolization Syndrome–Related Pain after Uterine Fibroid Embolization

“…The thought is that lidocaine results in temporary loss of sensation in the remaining patent myometrial branches that are intentionally preserved. 36 However, there was no significant reduction in pain levels in 7 to 24 hours following UFE in either study, likely due to the short half-life of lidocaine.…”

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

“…An intention-to-treat (ITT) analysis was not reported by Duvnjak and Andersen (2020), and so the perprotocol results from the study were used for the metaanalysis. Notably, in those RCTs that reported pain scores at several time points, statistically significant reductions in pain scores were noted at 2 h by Duvnjak and Andersen (2020) (PMD: − 1.82, p = 0.013) and at 4 h by Noel-Lamy et al (2017) (PMD: − 2.71, p < 0.001).…”

“…An intention-to-treat (ITT) analysis was not reported by Duvnjak and Andersen (2020), and so the perprotocol results were used in the analysis.…”

“…Of the former, all 3 were at high risk of bias with regards to the measurement of primary outcomes due to a lack of blinding, and there were some concerns regarding the randomization processes as detailed methods were not reported. There were additional concerns noted regarding missing data in Duvnjak and Andersen (2020). A summary of the quality assessment of cohort studies using the NOS tool is presented in Table 3.…”

Postembolization syndromein the treatment of uterine fibroids (a review)

“…Сразу после ЭМА внутриартериальное введение 10 мл 1 % лидокаина в маточную артерию в течение 15 секунд в проспективном рандомизированном контрольном исследовании показало уменьшение боли и снижение приема опиатов. Авторы также выявили, что применение лидокаина до процедуры ЭМА не допустимо, так как это приводит к неполному некрозу миомы матки, вероятно, из-за вазоспазма и применения эмболов более малых размеров во время ЭМА [27,28].…”