From the Guidelines
Pain typically occurs both during and after uterine fibroid embolization (UFE), with the most severe pain usually experienced in the first 24 hours after the procedure. During the procedure, patients may experience moderate to severe cramping pain when the embolic material blocks blood flow to the fibroids 1. After the procedure, post-embolization syndrome can cause significant pelvic pain, cramping, nausea, vomiting, fatigue, and low-grade fever for 2-7 days 1.
Causes of Pain
The pain occurs because cutting off blood supply to the fibroids causes tissue ischemia and inflammation, triggering pain receptors. Some key points to consider include:
- The procedure is typically performed under conscious sedation using either a unilateral or bilateral common femoral artery approach, depending on operator preference 2.
- Both uterine arteries are selectively catheterized, when possible, with the catheter advanced distal to nontarget branches 2.
- Particulate embolic agents are typically used to achieve distal embolization 2.
Pain Management
Pain management typically includes IV medications during the procedure (often narcotics and anti-inflammatory drugs), followed by oral pain medications for several days afterward. Some patients require hospitalization for 24 hours for pain control, while others can go home the same day with appropriate pain medication. Most patients find that pain peaks within the first 24 hours and gradually improves over several days, though some discomfort may persist for 1-2 weeks as the fibroids begin to shrink. According to the most recent study, UAE has been shown to cause persistent decreases in pain, heavy menstrual bleeding, and an average decrease in uterine fibroid size of >50% at 5 years 1.
From the Research
Pain Occurrence with Uterine Embolization for Fibroids
- The pain associated with uterine artery embolization (UAE) for fibroids can occur during and after the procedure 3, 4.
- Studies have shown that pain after UAE is a common symptom, often accompanied by other symptoms such as nausea, vomiting, and fever 3, 5.
- The time course of pain after UAE has been found to follow a predictable pattern, increasing over the first 2 hours after the procedure and then plateauing for several hours before decreasing 4.
- Pain management protocols, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and other medications, are crucial in controlling post-procedural pain 3, 5, 6, 7.
- The effectiveness of different pain management protocols has been compared in various studies, with some finding that certain protocols, such as those using morphine patient-controlled analgesia, may be more effective in reducing post-procedural pain than others 7.
- The use of opioids, NSAIDs, and other medications can help control pain and other symptoms after UAE, allowing for same-day discharge in some cases 5, 6.