Pain Management Protocols During Uterine Fibroid Embolisation: A Systematic Review of the Evidence

Saibudeen, Affan; Makris, Gregory C.; Elzein, Ahmed; Wigham, Andrew; Patel, R; Husainy, Mohammad Ali; Anthony, Suzie; Uberoi, Raman

doi:10.1007/s00270-019-02327-1

Cited by 16 publications

(14 citation statements)

References 25 publications

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“…Therefore, very simple intraarterial lidocaine administration in total doses of 200 mg is preferable in our opinion despite the limited long-term pain effect due to lidocaine metabolism. A recent published systemic review emphasises the need for more evidence, and no clear advantage of any of the used methods for pain control after UFE have been demonstrated so far (Saibudeen et al 2019).…”

Section: Discussionmentioning

confidence: 99%

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

Duvnjak

Andersen

2020

CVIR Endovasc

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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.

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Section: Discussionmentioning

confidence: 99%

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

Duvnjak

Andersen

2020

CVIR Endovasc

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“…Compared with the pain caused by other treatment alternatives (Saibudeen et al 2019), the NRS with the 1À4 range indicates that such degree of intra-operative pain can be bearable. Although one patient could not complete the treatment because of the pain, her intolerance to the treatment may be caused by the lumbar disk herniation.…”

Section: Patient Experience and Aesmentioning

confidence: 97%

“…The total sonication time did not last long, which could result in low near-field temperature elevation (Mougenot et al 2011). The pelvic pain may be caused by inflammation, and the vessel occlusion could also cause pain (Liu et al 2018;Saibudeen et al 2019). Abnormal vaginal discharge may be associated with the effect of endometrium (Liu et al 2018).…”

Section: Patient Experience and Aesmentioning

confidence: 99%

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Zhou

Niu

et al. 2021

Ultrasound in Medicine & Biology

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This study aimed to establish the feasibility of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for devascularization of uterine fibroids. Ultrasound color Doppler flow imaging (CDFI) and B-mode imaging were used to target fibroid vascularity. The vessels were covered and ablated by high-intensity focused ultrasound spots. In this study, 42 fibroids with a volume of 66.98 § 4.00 cm 3 were treated. No blood flow was detected by post-treatment CDFI in 40 fibroids. The 6-mo non-perfusion volume rate was 75.23% § 34.77% (n = 40). The mean shrinkage in fibroid volume was 38.20% and 43.89%, respectively, at 1 and 6 mo after treatment (p < 0.001). The uterine fibroid symptom and quality of life scores were reduced by 9.43% at 1 mo and 26.66% at 6-mo after treatment (p < 0.001). No serious adverse event was observed. This study demonstrates the feasibility of USgHIFU-induced fibroid devascularization, and more studies are required for the evaluation of safety and efficacy.

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“…Similar to this review, a previous systematic review published in 2019 assessed various pain management protocols in uterine fibroid embolisation, including intra-arterial administration of anaesthetic (Saibudeen et al 2019). It included 3 studies on UFE and concluded that intra-uterine drug administration provided slightly better pain control compared to other analgesic protocols whilst having no significant effect on the length of hospital stay.…”

Section: Discussionmentioning

confidence: 94%

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

Shiwani

2021

CVIR Endovasc

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Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay.

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Pain Management Protocols During Uterine Fibroid Embolisation: A Systematic Review of the Evidence

Cited by 16 publications

References 25 publications

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

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

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

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

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