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Semin intervent Radiol 2021; 38(05): 588-594
DOI: 10.1055/s-0041-1739161
Trainee's Corner

Management of Postprocedural Uterine Artery Embolization Pain

Johannes L. du Pisanie
1   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
,
Clayton W. Commander
1   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
,
Charles T. Burke
1   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
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Since the first uterine artery embolization (UAE) procedures were performed by Ravina in 1995, UAE has become accepted as a safe and effective alternate method for the treatment of uterine fibroids.[1] [2] [3] [4] UAE is a minimally invasive method for treating fibroids and adenomyosis with shorter postoperative recovery times and faster returns to normal daily activities compared with hysterectomy.[5] Even with a growth in its popularity, the number of UAEs performed to treat uterine fibroids compared with hysterectomies remains low.[3] [4] It has been postulated that one barrier to wider acceptance of UAE among providers and patients is the perception that post-UAE pain is severe and difficult to control.[6] Pain is the most reported symptom associated with UAE with approximately 90% of patients experiencing some level of postoperative pain compared with 30% intraoperatively.[3] [7] Post-UAE pain can be accompanied by other symptoms including fever, nausea, vomiting, and malaise which has been termed “postembolization syndrome” (PES) and can be seen in up to 30 to 40% of patients postprocedurally.[3] [8] [9] Both post-UAE pain and PES stem from inflammatory mediators released secondary to ischemia.[3] [8] [9] The foundation of pain management for UAE involves managing pain at its various physiologic sites including the following: the reception/transmission of painful stimuli (local anesthesia, intrauterine arterial anesthesia, and nerve blocks), the production of inflammatory mediators (steroidal and nonsteroidal anti-inflammatory medications), and the recognition of pain by the central nervous system (opiate analgesia).[10] Although many periprocedural UAE pain management approaches and interventions have been proposed and studied, no consensus guidelines exist to date.[11] Management styles between providers differ considerably and as such this article aims to serve as a guide for trainees through the various multimodal noninvasive and invasive approaches employed to prevent and treat peri-UAE pain.



Publication History

Article published online:
24 November 2021

© 2021. Thieme. All rights reserved.

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