Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging

Abstract

The purpose of the study was to evaluate uterine ischaemia after uterine artery embolisation (UAE) using magnetic resonance imaging and the role of myometrial and fibroid ischaemia in the pathogenesis of post-procedural pain. T1-weighted gradient echo imaging before and after contrast agent was performed on 62 women before and 24 h after UAE. We assessed the severity (mild, moderate, severe) of myometrial ischaemia, and the percentage and volume of ischaemic tissue in myometrium and fibroids. The Verbal Rating Scale was used to assess in-hospital post-procedural pain (1-3 mild, 4-6 moderate, 7-10 severe). Mean maximal pain was 7.7. Myometrial ischaemia was mild, moderate and severe in 29, 23 and 10 patients, respectively. Moderate or severe myometrial ischaemia (p = 0.041), the percentage (p = 0.037) and volume (p = 0.012) of ischaemic tissue in the myometrium, and a large volume of embolic material (p = 0.038) correlated with severe pain. In summary, pain following UAE is common and partly explained by myometrial ischaemia.

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

“…The mechanisms of uterine pain with UAE are thought to involve pelvic cramping associated with postinfarction myometrial ischemia [25], a type of visceral pain. The natural history of PI associated with UAE is that it remains severe during and for several hours after UAE and then decreases in intensity [4].…”

Preinterventional quantitative magnetic resonance imaging predicts uterus and leiomyoma size reduction after uterine artery embolization

“…UAE was performed as previously described with calibrated microsphere particles (550–700 μm) (EmboSphere; BioSphere Medical, Louvres, France) (6). The embolization was stopped when stasis or near stasis was observed in the ascending segment of the uterine artery.…”

Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization

“…7 Pelvic cramping most likely due to postembolization myometrial ischaemia and fibroid infarction causes this pain. 8 Even if successful outpatient UAE has been described, it requires an effective pain treatment such as epidural analgesia or high doses of i.v. opioids, 7 mostly morphine which requires sometimes overnight hospitalization.…”