Abstract
Uterine artery embolization has Level A data supporting excellent safety and efficacy
in treating symptomatic uterine leiomyomata. However, there is a perception that either
postprocedural pain is severe or poorly managed by the physician performing these
procedures. This has led some primary care physicians to omit this procedure from
the patients' options or to steer patients away from this procedure. A few simple
techniques (pruning of the vascular tree and embolizing to 5–10 beat stasis) and fastidious
pre-, intra-, and post-procedural management can nearly eliminate significant pain
associated with embolization. Specifically, early implementation of long-acting low-dose
narcotics, antiemetics and anti-inflammatory medications is critical. Finally, the
use of a superior hypogastric nerve block, which takes minutes to perform and carries
a very low risk, significantly reduces pain and diminishes the need for narcotics;
when this technique was used in a prospective study, all patients were able to be
discharged the day of the procedure. In the authors' experience, patients treated
in this manner largely recover completely within 5 days and have a far less traumatic
experience than patients traditionally treated with only midazolam (Versed) and fentanyl
citrate (fentanyl) intraprocedurally, and narcotics and nonsteroidal antiinflammatory
drugs postprocedurally.
Keywords
uterine fibroid embolization - UAE - pain - superior hypogastric nerve block - postembolization
syndrome - interventional radiology
