Pain,Nausea, and Hospital Admission after Uterine Fibroid Embolization: A Comparison of 2 Protocols |
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| Affiliation: | 1. Department of Radiology, Kaiser Permanente Oakland Medical Center, Oakland, California;2. Department of Radiology, Kaiser Permanente Richmond Medical Center, Richmond, California;3. Department of Psychology, George Mason University, Fairfax, Virginia;1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois;2. Department of Medicine, Section of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois;3. Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois;1. Université Paris Cité, Paris, France;2. Assistance Publique-Hôpitaux de Paris.Nord, Hôpital Bichat, Department of Vascular and Thoracic Surgery and SURVI (Structure d’URgences Vasculaires Intestinales-Intestinal Stroke Center), Paris, France;3. Inserm, UMR_S 1140, Innovations thérapeutiques en hémostase, Laboratoire de recherches biochirurgicales de la Fondation Carpentier;4. Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina;5. Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon.Nord, Department of Radiology and SURVI (Intestinal Stroke Center), Paris, France;6. Assistance Publique-Hôpitaux de Paris.Nord, Hôpital Beaujon, SURVI, Service de Gastroentérologie, MICI et Assistance Nutritive, Paris, France;7. Assistance Publique-Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Department of Vascular Surgery, Paris, France;1. Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania;4. Division of Vascular and Interventional Radiology, Department of Radiology, University of California San Diego, La Jolla, California;1. Department of Radiology, Seattle Children’s Hospital, Seattle, Washington;2. University of Wisconsin Health Services, Madison, Wisconsin;1. Long Island Jewish Medical Center, Northwell Health System, Queens, New York;2. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York;3. Zucker School of Medicine at Hofstra University/Northwell Health System, Hempstead, New York;4. Icahn School of Medicine at Mount Sinai Hospital, New York, New York |
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| Abstract: | Uterine fibroid embolization (UFE) procedures performed from 2013 to 2019 were reviewed. Seventy-two patients were treated with a standard protocol consisting of sedation, ketorolac, ondansetron, and overnight parenteral analgesics and antiemetics. Ninety-six patients were treated with a new protocol, which added transdermal scopolamine, lorazepam, and intravenous acetaminophen. Outpatient uterine fibroid embolization (OP-UFE) not requiring hospitalization was successful in 81.4% and 2.7% of patients treated with the new and old protocols, respectively (odds ratio [OR], 141.4; P < .0001). Procedural fentanyl doses were lower with the new protocol than with the old one (mean, 148 vs 186 mcg; P = .0016). In the new protocol subset, patients were 1.01 times more likely to fail OP-UFE for every microgram increase in procedural fentanyl (OR, 0.99, P = .009), and those presenting with pain were less likely to succeed with OP-UFE than those with bleeding or bulk symptoms (OR, 0.31, P = .04). In conclusion, decreasing the opioid dose while increasing the antiemetic and nonopioid analgesic medications improves the chances of same day discharge after UFE. |
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