title: Comparison of pain after uterine artery embolization using tris-acryl gelatin microspheres versus polyvinyl alcohol particles.
abstract: When compared in a uterine artery embolization (UAE) animal model, Embospheres (ES) (Biosphere Medical, Rockland, MA) were found to induce less uterine ischemia than polyvinyl alcohol (PVA) particles. Given this finding, we aimed to test the hypothesis that ES is associated with less pain after UAE than PVA in human patients. We performed retrospective analysis on data from 72 consecutive UAE patients, collected from a prospectively acquired database. Patient-controlled analgesia (PCA) pump-delivered morphine sulfate (MS) dosages were compared between patients who received ES versus PVA. Subjective pain scores (SPS) were also compared between the two groups. Secondary outcome measures, including embolic volume and clinical outcome data, were also collected. Linear regression and t-test statistical analyses were performed. Null hypotheses were rejected at the p < 0.05 level. Mean follow-up period in the PVA population was 178 days (range 28-426), versus 96 days (range 24-197) in the ES population. The mean MS doses used by ES and PVA patients were 37.2 (s.d. 23.5) versus 47.1 (s.d. 26.8), respectively. This difference was not significant (p > 0.15). Utilizing a standard 0-10 pain scale, the mean peak SPS for the ES and PVA groups were 5.58 (s.d. 2.77) and 5.07 (s.d. 2.99), respectively. The difference was not significant. The mean amount of embolic material used in each ES and PVA patient was 4.86 cc (s.d. 3.01) and 3.52 cc (s.d. 1.63), respectively. The difference revealed a strong trend toward statistical significance (p = 0.05). There was one treatment failure in each group of patients. Within both patient samples, no significant correlation was found when comparing the volume of embolic used and subsequent MS dose. Despite a strong trend toward a significantly higher volume of ES used per patient, there is no subjective or objective difference in pain after UAE with ES when compared to PVA.
authors.affiliation: Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA. rkryu@hotmail.com
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sichlau
authors.forename: Aheed
authors.initials: A
authors.lastname: Siddiqi
authors.forename: Howard B
authors.initials: HB
authors.lastname: Chrisman
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vogelzang
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D016022:Case-Control Studies; D004621:Embolization, Therapeutic; D005260:Female; D005780:Gelatin; D006801:Humans; D007889:Leiomyoma / Q000628:therapy; D008863:Microspheres; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D011142:Polyvinyl Alcohol; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000628:therapy; D014599:Uterus / Q000098:blood supply*
chemical_list: D005780:Gelatin; D011142:Polyvinyl Alcohol