Intraarterial lidocaine for pain control after uterine artery embolization for leiomyomata.
OBJECTIVE
To evaluate the effectiveness of intraarterial lidocaine in controlling pain after uterine artery embolization (UAE).


METHODS
In this double-blind prospective study, patients undergoing UAE received preservative-free 1% lidocaine or saline solution (control) in the uterine arteries before embolization. Postprocedural pain was managed with patient-controlled intravenous morphine. Attempted doses, number of doses received, total morphine dose, and maximum pain numeric rating scale (NRS) score during the postprocedural hospitalization were recorded and compared. Three-month follow-up magnetic resonance (MR) imaging and symptomatic questionnaires were collected and compared.


RESULTS
Ten patients received lidocaine and eight patients received placebo. Moderate to severe vasospasm was noted in seven patients after lidocaine injection, whereas no vasospasm was noted in the placebo group (P =.004). Patients in the lidocaine group had lower NRS pain scores than those in the placebo group (P =.012), whereas there was no difference in morphine requirement between treated patients and control subjects. The study was terminated after 18 patients were treated as a result of unexpected vasospasm.


CONCLUSIONS
Intraarterial 1% lidocaine is associated with moderate to severe vasospasm. Lidocaine significantly lowers subjective pain, but there is no difference in analgesic requirements. The routine use of intraarterial lidocaine is not recommended for pain control until the long-term effects of vasospasm on outcome is known.
Keyoung
J A
JA
Department of Radiology, Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC 20007-2197, USA.
Levy
E B
EB
Roth
A R
AR
Gomez-Jorge
J
J
Chang
T C
TC
Spies
J B
JB
D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D007889:Leiomyoma / Q000098:blood supply / Q000628:therapy*; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014594:Uterine Neoplasms / Q000098:blood supply / Q000628:therapy*; D014599:Uterus / Q000098:blood supply
D000779:Anesthetics, Local; D008012:Lidocaine