Cutting-Edge IV Pain Management: Making UFE as Comfortable as Possible
Alicia Armeli

Almost four out of five women will have uterine fibroids by age 50.1 Although many women with fibroids don’t experience any bothersome symptoms, nearly half will seek treatment for relief from heavy painful periods, pelvic pressure, and urinary urgency.2 For these women, having effective treatment options is a must.

One such option, uterine fibroid embolization (UFE), is a minimally invasive uterine-sparing procedure that completely resolves symptoms in nearly 90% of women who undergo the treatment.3 Even with a stellar success rate, a team of researchers at University of California Los Angeles is continuously working to improve the procedure in areas of pain management with the goal of enhancing patient comfort and the overall UFE experience.

“With UFE, we’re always working on making it pain-free and nausea-free,” says Cheryl Hoffman, MD, co-author of the study, Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA, and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. “UFE is a very effective procedure, but the one downside is pain and nausea particularly in the first 6 to 12 hours after the procedure. Because of this, we’re constantly looking for techniques that can make the procedure more comfortable.”

The small study included 40 UFE patients randomly divided into four groups and assigned either 1 g of intravenous (IV) acetaminophen—commonly known as Tylenol® (4 patients), 800 mg of IV ibuprofen—commonly known as Advil® (4 patients), combined 1 g of IV acetaminophen and 800 mg of IV ibuprofen (16 patients), or 30 mg of IV ketorolac—a non-steroidal anti-inflammatory drug (NSAID) (16 patients).4

“In this study, instead of having a control group—a group that didn’t receive any pain medication—we gave one group ketorolac, which is the standard of care in pain management, to see how it measured up against the other medications,” Dr. Hoffman tells Ask4UFE. “The protocol is to layer an NSAID, followed by acetaminophen, followed by a higher opioid. Among other side effects, opioids can cause nausea. We compared reported pain and nausea and the amount of opioid and anti-nausea medication required by each group.”

At 6-hour intervals, patients reported pain using a 10-point visual analogue scale (VAS) and the total amounts of opioid (morphine) and anti-nausea medication (Zofran) use per group were recorded.

Results were presented at the 2017 Society of Interventional Radiology Scientific Session and are being submitted to the Journal of Vascular and Interventional Radiology.

Although there were no differences in pain scores among the groups, the researchers found that less total opioid medication was required for the combined acetaminophen/ibuprofen group (28.09 mg) in comparison to the ketorolac group (40.33 mg). No differences were seen in total anti-nausea medication required by both groups, but the combined acetaminophen/ibuprofen group reportedly experienced more nausea.

“It was good that the combined acetaminophen/ibuprofen group used less opioids because these medications can have other negative side effects like constipation and brain fog. Using less opioids allows patients to get up and walk around more and feel healthier after UFE,” Dr. Hoffman emphasizes. “What was confusing about our data, and what we’ll have to investigate further, is why the combined acetaminophen/ibuprofen group experienced more nausea.”

Even though Hoffman and her team are calculating their next steps in this area of research, they’ve already taken strides in other areas of UFE pain management and patient care. “My interventional radiology practice is now 100% radial access,” Dr. Hoffman says regarding an innovative approach to UFE that treats fibroids through a tiny pinhole made in the wrist. “We have IV pain management protocols that we’re perfecting for this approach that are effective and cost efficient. UFE patients are really happy and loving the radial approach.”

Data have shown that the radial approach is patient-preferred over the traditional femoral access site in the upper thigh.5 Patient comfort benefits of the radial approach include urinating without a foley catheter, walking around after the procedure, and the possibility of going home the same day.

“That’s what we’re all about,” Dr. Hoffman explains. “We’re always looking for cutting-edge ways to make UFE as comfortable and safe for patients as possible because it’s such a successful minimally invasive procedure that should be considered before surgical options.” 

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

ABOUT THE DOCTOR   Cheryl Hoffman is a Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. She is American Board Certified in vascular and interventional radiology, as well as diagnostic radiology. Through patient care and research, Dr. Hoffman builds public awareness around uterine fibroids and all treatment options available with the goal of helping women everywhere live optimally. For more information regarding the study, please contact Dr. Hoffman, MD at [email protected]

 

REFERENCES

  1. Our Bodies Ourselves. (n.d.). Fibroids. Retrieved from http://www.ourbodiesourselves.org/health-info/fibroids/
  2. Soliman, A. M., Yang, H., Du, E. X., Kelkar, S. S., & Winkel, C. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug; 213(2): 141-160.
  3. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, Aug; 2: 1-7.
  4. Chaabane, S., Hoffman, C., Kim, G., et al. (2017). A prospective, double-blind, randomized controlled study evaluating the effects of two new IV medications, IV acetaminophen and/or IV ibuprofen, on standard of care pain and antiemetic management in uterine fibroid embolization patients. J Vasc Interv Radiol, Feb; 28(2): S47-S48.
  5. Jolly, S. S., Yusuf, S., Cairns, J., et al. (2011). Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet, Apr; 377(9775): 1409-1420.