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

  • Affan Saibudeen
  • Gregory C. MakrisEmail author
  • Ahmed Elzein
  • Andrew Wigham
  • Rafiudin Patel
  • Mohammad Ali Husainy
  • Suzie Anthony
  • Raman Uberoi



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.


Uterine artery embolisation Fibroids Pain management 


Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Affan Saibudeen
    • 1
  • Gregory C. Makris
    • 2
    • 3
    Email author
  • Ahmed Elzein
    • 2
  • Andrew Wigham
    • 2
  • Rafiudin Patel
    • 2
  • Mohammad Ali Husainy
    • 2
  • Suzie Anthony
    • 2
  • Raman Uberoi
    • 2
  1. 1.University of OxfordOxfordUK
  2. 2.Vascular and Interventional Radiology DepartmentOxford University Hospitals, NHS Foundation TrustOxfordUK
  3. 3.Alfa Institute of Biomedical SciencesMarousiGreece

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