Post-Uterine Artery Embolization Pain and Clinical Outcomes for Symptomatic Myomas Using Gelfoam Pledgets Alone Versus Embospheres Plus Gelfoam Pledgets: A Comparative Pilot Study

Abstract

BackgroundTo evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids. MethodWe conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700mg) plus Gelfoam under conscious sedation and local anaesthesia. This was followed by patient-controlled analgesia (PCA) using a morphine pump overnight.Post-procedural pain was assessed by the mean amount of self-administered morphine delivered by PCA pump (mL) from 0 to 19hours in each group. The mean volumes of the uterus and the dominant fibroid were calculated by ultrasound at baseline, three months, six months, and 12months. ResultsA total of 17 women participated in the study. Bilateral uterine artery occlusion was performed in eight women using Gelfoam alone, and in nine women using Embosphere+Gelfoam. One woman in the Embosphere+Gelfoam group developed a puncture-site hematoma requiring further intervention one week later. The mean (SD) amount of morphine self-administered by PCA pump at time 0, 1, and 2hours was 3.4mg (3.1), 2.9mg (2.2), and 2.4mg (3.3) in the Gelfoam-only group and 6.1mg (3.0), 9.6mg (7.1), and 5.3mg (4.4) in the Embosphere+Gelfoam group, respectively. After three hours, the amount of morphine used was equal in both groups. The mean (SD) total dose of morphine used was 29.5mg (18.6) in the Gelfoam group and 41.1mg (19.3) in the Embosphere+Gelfoam group (P=0.228). At 12months, the reduction in median total uterine volume and median dominant fibroid volume in each group was equal. ConclusionClinical outcomes were equivalent after uterine artery embolization using Gelfoam alone versus Gelfoam+Embospheres. Although the amount of immediate post-procedure pain may be less with Gelfoam alone, we could not demonstrate this objectively using morphine use as a measure of pain.