SIR 2024
Women's Health
Kenneth Briley, MD, PhD
Resident Physician
University of Miami, Miller School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Arais Cavada, ARNP
Supervisor, Advanced Practice Providers
Jackson Health System/UHealth System
Disclosure information not submitted.
Issam Kably, MD
Assistant Professor of Clinical Interventional Radiology
University of Miami Miller School of Medicine
Disclosure information not submitted.
Shivank Bhatia, MD
Professor of Interventional Radiology
University of Miami
Financial relationships: Full list of relationships is listed on the CME information page.
Jose Carugno, MD
Asscoiate Professor, Clinical Director, Minimally Invasive Gynecologic Surgery
University of Miami
Disclosure information not submitted.
Ira Karmin, MD
Assistant Professor Division of Gynecology Department of Obstetrics, Gynecology & Reproduction
Jackson Health System/UHealth System
Disclosure information not submitted.
Prasoon Mohan, MD
Asscociate Professor
Department of Interventional Radiology, University of Miami- Miller School of Medicine
Disclosure information not submitted.
One of the major practical considerations for uterine fibroid embolization (UFE) is the post procedural pain. Prior research has shown that preprocedural administration of a single dose of dexamethasone is helpful in alleviating the pain following UFE as it controls inflammation. Intraarterial administration of a drug can result in higher intra-organ concertation the drug avoids first pass metabolism and systemic dilution. The aim of this study is to test if administration of dexamethasone intraarterially during UFE alleviates post procedural pain.
Materials and Methods:
This IRB approved study was designed as a double blinded randomized controlled trial. The randomization was done and the records were kept by the research pharmacy, who had no role in the clinical aspects of the study. The drug or placebo was delivered in identical syringes and during the procedure, 5 mg of dexamethasone or placebo was delivered into each uterine artery prior to embolization. Pain scores were collected using visual analog scores of 0 to 10 at immediate, 1, 2 3, 6, 9, 12 and 24 hrs after the procedure and post operative day 2. Nausea and vomiting were measured on a scale of 1 to 3.
Results:
A total of 42 patients were recruited. The mean age of the cohort was 44.7 (4.7) years. Twenty patients each received the drug or placebo. The mean pain score at 24 hrs was 2.5 (2.4) and 4.2 (2.9) in the test and control groups respectively (p=0.04). The mean pain score at post op day 2 was 2.7 (3.2) and 5.05 (3) in the test and control groups respectively (p=0.02). The cumulative mean nausea and vomiting score for the first 24 hrs were 3.1 (3.4) and 4.1 (2.8) in the test and control groups respectively (p=0.29). Two patients were excluded: one for the use of a cannabis-containing product and another for a unilateral uterine artery embolization. Two patients were readmitted post-procedure with small access site hematomas. Both were treated conservatively and discharged.
Conclusion:
Dexamethasone administration intraarterially during UFE significantly improves post procedural pain at 24 hours and on post operative day 2. It did not have an effect on post procedural nausea and vomiting.