Pain Management Protocols During Uterine Fibroid Embolisation: A Systematic Review of the Evidence
Uterine fibroid embolisation (UFE) is an effective treatment for fibroids. There are varying analgesia protocols published to control procedure associated pain. We aimed to assess what protocols are most effective in controlling post-procedural pain.
Materials and Methods
A systematic review of the Embase and Medline databases was conducted according to PRISMA guidelines. Studies regarding analgesia protocols post-uterine fibroid embolisation with Visual Analogue Scale or Numerical Rating Scale pain scores were included. The mean maximal pain scores of patients post-procedure were evaluated. ANOVA and t tests were performed.
We identified 26 studies (total 3353 patients), with a mean procedural success rate of > 87%. We stratified protocols into four groups. Mean pain scores were: opioids ± NSAIDs ± acetaminophen (4.84, SD = 1.56); opioids ± NSAIDs ± acetaminophen + nerve block (4.7, SD = 1.37); opioids ± NSAIDs ± acetaminophen + intrauterine artery drug administration (4.09, SD = 0.60); and opioids ± NSAIDs ± acetaminophen + other (5.30, SD = 1.13) without significant difference between groups (p = 0.71). Similarly, there was no difference (p = 0.057) between groups for time to discharge or side effects.
There is no evidence to suggest that there is any superiority of one protocol above another in the published literature. Appropriate use of opioids ± NSAIDs ± acetaminophen alone appears to be sufficient to control pain post-UFE. However, due to large heterogeneity of the literature no firm conclusions can be reached, and further research is warranted.
Level of Evidence
Level 1, Systematic review.
KeywordsUterine artery embolisation Fibroids Pain management
Compliance with Ethical Standards
Conflict of interest
The authors declare they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, informed consent is not required.
Consent for Publication
For this type of study, consent for publication is not required.
- 5.Lipszyc M, Winters E, Engelman E, Baurain M, Barvais L. Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization. Br J Anaesth. 2011;106:724–31.CrossRefGoogle Scholar
- 7.Nemcek AA, Sichlau M, Vogelzang R. Comparison of pain after uterine artery embolization using tris-acryl gelatin microspheres versus polyvinyl alcohol particles. Cardiovasc Intervent Radiol. 2004;26:375–8.Google Scholar
- 9.Chiu CY, Wong WK, Mak HL, Chan CS, Kwok CH, Chan CH, Chan MK. Uterine artery embolisation for treatment of fibroids: experience in Chinese women. Singap Med J. 2001;42:148–54.Google Scholar
- 11.McCullough M, et al. Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol. 2012;15:793–800.Google Scholar
- 13.Barnard EP, et al. Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis. Am J Obs Gynecol. 2017;216:87–97.Google Scholar
- 14.Tran C, et al. Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario uterine fibroid embolization trial. J Vasc Interv Radiol. 2012;14:1243–50.Google Scholar
- 19.Konstantatos AH, et al. 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. Cardiovasc Intervent Radiol. 2014;37:1191–7.CrossRefGoogle Scholar
- 25.Hehenkamp WJK, Volkers NA, Birnie E, Reekers JA, Ankum WM. Pain and return to daily activities after uterine artery embolization and hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Cardiovasc Intervent Radiol. 2006;29:179–87.CrossRefGoogle Scholar
- 29.Kim SY, et al. 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 st. J Vasc Interv Radiol. 2013;24:779–86.CrossRefGoogle Scholar
- 31.Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22(6):562–8.Google Scholar