Analgesic strategies in the management of postoperative pain following uterine artery embolization for symptomatic fibroids: a systematic review.

PURPOSE: To identify and compare anesthetic and analgesic strategies employed during uterine artery embolization for symptomatic leiomyomas, assessing their effectiveness in reducing postoperative pain and opioid use and evaluating complication rates.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Embase, Web of Science, and Scientific Electronic Library Online. Randomized controlled trials and prospective cohort or case-control studies, published in the last 10 years, evaluating pain, opioid consumption, and/or complications, were included.

RESULTS

The total of 3,433 studies were screened, of which six met eligibility criteria. Superior hypogastric plexus block reduced pain and opioid use. Intra-arterial lidocaine decreased pain within 2-4 h and opioid consumption, with a transient effect; administration after vascular stasis was preferable. Controlled-release oxycodone reduced pain at 24 h and need for rescue medication without lowering mean consumption. Dexamethasone reduced pain at 12-24 h without impacting opioid use. No significant complications were reported.

CONCLUSION

In the ischemic phase of post-uterine artery embolization pain, a superior hypogastric nerve block appears to provide the most consistent relief, with intra-arterial lidocaine representing an alternative when resources are limited. For the inflammatory phase, intravenous dexamethasone is the preferred option, whereas controlled-release oxycodone may be considered only in refractory cases.