Reducing Post Procedural Pain and Opioid Consumption Using IV Acetaminophen and IV Ibuprofen Following Uterine Fibroid Embolization: A Prospective, Doubleblind, Randomized Controlled Study

Abstract

Purpose: Uterine fibroid embolization (UFE) is associated with post-procedural pain and nausea. In this double-blind randomized controlled study, we compared pre-procedure intravenous (IV) acetaminophen/ibuprofen to postprocedure IV ketorolac in UFE patients. Methods:After institutional review board approval, UFE candidates 21-60 years old were screened and randomly assigned to one of four arms: acetaminophen (1 g), ibuprofen (800 mg), acetaminophen (1 g) and ibuprofen (800 mg) combined, and an active comparator, ketorolac (30 mg). All received rescue patient-controlled hydromorphone for 24 h post-procedure. Primary outcome was measurement of pain intensity (visual analog scale: VAS) between the acetaminophen/ibuprofen group and the ketorolac group. The secondary outcomes were opioid and anti-emetic requirements and nausea intensity (VAS).Results: 40 subjects were analysed: acetaminophen/ ibuprofen (N=16); acetaminophen (N=4); ibuprofen (N=4); ketorolac (N=16). The maximum and mean VAS scores for pain were not different between the acetaminophen/ ibuprofen group and the ketorolac group without adjusting for opioid consumption (p=0. 243 and p=0.208, respectively). Total opioid consumption in morphine equivalents (mean [±SE]) was 28.09 mg (±4.58) in the acetaminophen/ibuprofen group and 40.33 mg (±7.79) in the ketorolac group (p=0.087), demonstrating a trend favouring the acetaminophen/ibuprofen group. The mean and maximum nausea scores showed a trend and significant difference (p=0.095 and p=0.003), respectively, favouring the ketorolac group. Conclusion:IV acetaminophen/ibuprofen demonstrated comparable pain control, although there was less opioid requirement for the acetaminophen/ibuprofen group compared to the ketorolac group. Maximum nausea scores were significantly increased with similar ondansetron requirements. Therefore, antiemetic prophylaxis is needed regardless of group.

Management of Postprocedural Uterine Artery Embolization Pain

“…The study showed that the IV acetaminophen þ ibuprofen group provided similar pain control with less opiate use compared with the ketorolac group (28.09 mg compared with 40.33 mg of morphine equivalents); however, there was more nausea experienced in the IV acetaminophen/ibuprofen group. 41 Discharge Medications Discharge medications rely on over-the-counter options such as NSAIDs and acetaminophen with the addition of oral opiate analgesia (oxycodone 5 mg/acetaminophen 325 mg) for break through pain. Antiemetics and stool softeners are also commonly provided.…”