title: Intraarterial Lidocaine for Pain Control in Uterine Artery Embolization: A Prospective, Randomized Study.
abstract: OBJECTIVE
  To assess efficacy of two different techniques of lidocaine injection in the uterine arteries to reduce pain following uterine artery embolization (UAE) for leiomyomas.
  
  
  METHODS
  This prospective randomized single-blinded study was performed with 60 patients enrolled between November 2014 and December 2015 equally randomized to 3 arms. Group A received 10 mL lidocaine 1% (100 mg) mixed with polyvinyl alcohol particles (355-500 μm). Group B received the same dose of lidocaine injected after embolization. Group C was a control group. Pain was assessed on a 100-point visual analog scale at 4, 7, and 24 hours after the procedure. Narcotic agent dose to 24 hours was recorded. Outcomes were examined by analysis of variance and pairwise comparison. Leiomyoma infarction was assessed with magnetic resonance imaging 3 months after the procedure.
  
  
  RESULTS
  Technical success rate of UAE was 100%. Mean pain score at 4 hours was significantly lower in the lidocaine groups (group A, 28.6; group B, 35.8) compared with the control group (59.4; P = .001). Pain scores at 7 and 24 hours were not statistically different among the 3 arms. The mean in-hospital narcotic agent dose was significantly lower in both lidocaine groups than in the control group (group A, 8.5 mg [P = .002]; group B, 11.1 mg [P = .03]; group C, 17.4 mg). There were no adverse events related to the use of lidocaine. The number of patients with complete infarction of leiomyomas at 3 months was significantly lower in group A at 38.9% (group B, 77.8%; group C, 75%; P = .0451).
  
  
  CONCLUSIONS
  Lidocaine injected in the uterine arteries reduced postprocedural pain and narcotic agent dose after UAE. There were more cases of incomplete necrosis when lidocaine was mixed with the particles.
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: maximenl@gmail.com.
authors.forename: Maxime
authors.initials: M
authors.lastname: Noel-Lamy
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kong T
authors.initials: KT
authors.lastname: Tan
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Simons
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sniderman
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Oleg
authors.initials: O
authors.lastname: Mironov
authors.affiliation: Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dheeraj K
authors.initials: DK
authors.lastname: Rajan
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000628:therapy*; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009864:Ontario; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011142:Polyvinyl Alcohol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011142:Polyvinyl Alcohol; D008012:Lidocaine