Pain Trajectories and Predictors Following Uterine Artery Embolization Using a Nitroglycerin-Lidocaine Protocol: A...

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Gynecologic Oncology

Background:

• Uterine artery embolization (UAE) is a key treatment for symptomatic uterine fibroids.
• Post-procedural pain is a significant limitation of UAE.
• Previous attempts using intra-arterial lidocaine had inconsistent results and safety concerns.

Purpose of the Study:

• To assess pain trajectories after UAE using a novel protocol.
• To identify predictors of post-procedural pain severity.
• To evaluate the safety and efficacy of prophylactic intra-arterial nitroglycerin followed by lidocaine.

Main Methods:

• Prospective single-arm study of 34 women undergoing UAE.
• Administration of intra-arterial nitroglycerin before embolization to prevent vasospasm.
• Infusion of intra-arterial lidocaine post-embolization.
• Pain intensity measured using Visual Analog Scale (VAS) at multiple time points.

Main Results:

• The protocol was technically successful without complications or vasospasm.
• Mean VAS pain peaked at 3 hours post-procedure and subsequently declined.
• Largest fibroid volume positively correlated with mean pain and early post-procedural pain.
• The lidocaine regimen was well-tolerated and did not impact embolization outcomes.

Conclusions:

• The sequenced protocol of intra-arterial nitroglycerin and lidocaine is safe and effective for managing UAE-related pain.
• Largest fibroid volume is a predictor of increased post-UAE pain.
• Further randomized trials are warranted to optimize this analgesic approach for uterine fibroid treatment.