Noel-Lamy Maxime, Tan Kong T, Simons Martin E, Sniderman Kenneth W, Mironov Oleg, Rajan Dheeraj K
Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
J Vasc Interv Radiol. 2017 Jan;28(1):16-22. doi: 10.1016/j.jvir.2016.10.001. Epub 2016 Nov 22.
To assess efficacy of two different techniques of lidocaine injection in the uterine arteries to reduce pain following uterine artery embolization (UAE) for leiomyomas.
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.
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).
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.
评估两种不同的利多卡因子宫动脉注射技术在子宫肌瘤子宫动脉栓塞术（UAE）后减轻疼痛的效果。
这项前瞻性随机单盲研究纳入了60例患者，这些患者于2014年11月至2015年12月期间入组，并被平均随机分为3组。A组接受10 mL 1%利多卡因（100 mg）与聚乙烯醇颗粒（355 - 500μm）混合。B组在栓塞后注射相同剂量的利多卡因。C组为对照组。在术后4小时、7小时和24小时采用100分视觉模拟量表评估疼痛程度。记录至24小时的麻醉剂用量。通过方差分析和两两比较来检验结果。术后3个月用磁共振成像评估子宫肌瘤梗死情况。
UAE的技术成功率为100%。利多卡因组（A组，28.6；B组，35.8）术后4小时的平均疼痛评分显著低于对照组（59.4；P = 0.001）。3组在术后7小时和24小时的疼痛评分无统计学差异。两个利多卡因组的平均住院麻醉剂用量均显著低于对照组（A组，8.5 mg [P = 0.002]；B组，11.1 mg [P = 0.03]；C组，17.4 mg）。未发生与利多卡因使用相关的不良事件。术后3个月，A组子宫肌瘤完全梗死的患者数量显著低于其他组，为38.9%（B组，77.8%；C组，75%；P = 0.0451）。
子宫动脉注射利多卡因可减轻UAE术后的疼痛和麻醉剂用量。当利多卡因与颗粒混合时，不完全坏死的病例更多。
