Effectiveness of intra-arterial lidocaine for pain control after uterine artery embolization: a prospective randomized study.

Presented During:   Arterial Embolization: UFE
Sun, 4/3/2016: 3:09 PM  - 3:18 PM 
Vancouver Convention Centre  
Room: 118  

Final ID:

30 

Submission Number:

135 

Abstract Type:

Original Scientific Research-Oral or Poster 

Authors:

M. Noël-lamy1, M. Simons1, O. Mironov2, K. Tan3, K. Sniderman1, D. Rajan1

Institutions:

1University Health Network, Toronto, ON, 2University Health Network, Toronto, Ontario, 3University of Toronto, Toronto, Ontario

Abstract Presenter:

Maxime Noël-lamy, MD  
University Health Network
Toronto, ON

Co-Author(s):

Oleg Mironov Dr  
University Health Network
Toronto, Ontario
Dheeraj K. Rajan, MD, FRCPC, FSIR  
University Health Network
Toronto, ON
Martin E. Simons, MD, FRCP(C), FSIR  
University Health Network
Toronto, ON
Kenneth W. Sniderman, MD, FSIR  
University Health Network
Toronto, ON
Kong Teng Tan MD FRCPC  
University of Toronto
Toronto, Ontario

Purpose:

To prospectively assess the effectiveness of intra-procedural uterine artery lidocaine injection to reduce pain following uterine artery embolization (UAE) for fibroids. Secondarily, to compare the effectiveness of two different techniques of lidocaine administration.

Materials:

This IRB approved prospective, randomized controlled single-blind study was performed at a single center. UAE was performed as an outpatient procedure. 54 patients enrolled between November 2014 and September 2015 were equally randomized to 3 arms. Group A was a control group, group B received 10mL of lidocaine 1% (100mg) mixed with the first vial of particles (355-500µm polyvinyl-alcohol) injected into each uterine artery. Group C received the same dose of lidocaine, but injected after the embolization. Pain was assessed using a 100-points visual analog scale (VAS) at 4, 7 and 24 hours post-procedure. Narcotic dose to 24h and time to discharge were recorded. Outcomes were examined using analysis of variance (ANOVA). The comparison of the three groups was examined with model contrasts.

Results:

Technical success of UAE was 100%. Pain at 4 hours was significantly lower in the lidocaine groups (mean B=29, C=36) compared to control group (mean=61) [p=0.001], with no significant difference between the two test groups [p=0.4]. Pain at 7 and 24 hours was not statistically different among the three arms. The in-hospital narcotic dose converted to an equivalent in milligrams of intra-venous morphine was significantly lower in group B compared to the control group [p=0.01], but not for group C compared to control arm or group B compared to group C (mean A= 17.8mg, B= 8.3mg, C=11.4mg). There was no significant difference in post-procedure length of stay (mean A=10.3h, B=8.1h, C=10.5h). Patient age, uterine volume, procedure time, parity status and ethnicity did not differ significantly between groups. There was no adverse event related to the use of lidocaine.

Conclusions:

Lidocaine injected in the uterine arteries, either mixed with the particles or administered after embolization, reduced post-procedural pain in the first 4 hours following UAE. Mixing lidocaine with the embolization particles reduced the in hospital narcotic dose.

Abstract Categories:

Arterial Interventions: Embolization

Keywords:

Lidocaine
Pain control
Uterine artery embolization (UAE)