Intraarterial dexamethasone may be effective for pain relief following uterine fibroid embolization

1. Intraarterial dexamethasone was associated with greater pain relief after uterine fibroid embolization compared with placebo. 

Evidence Rating Level: 1 (Excellent)

Uterine fibroid embolization (UFE) is a minimally invasive treatment for symptomatic uterine fibroids, which are most common tumor of the female reproductive tract. However, a major limitation of UFE is acute postprocedural pain. Intravenous (IV) dexamethasone administered prior to UFE has previously been associated with reductions in pain severity. It is unknown whether intraarterial dexamethasone administration during UFE would further reduce postprocedural pain after UFE. This study thus examined whether intraarterial dexamethasone reduced postprocedural pain after UFE compared with placebo. This randomized clinical trial included women aged 20 to 50 years in the US undergoing UFE between July 2020 and December 2023. Participants were randomized 1:1 to receive either intraarterial dexamethasone (10 mg) or saline placebo during embolization. The primary outcome was postprocedural pain through 168 hours (7 days). Among the 42 women randomized (mean [SD] age, 44.7 [4.7] years), 40 women were analyzed with 20 in the dexamethasone group and 20 in the placebo group. Compared with placebo, intraarterial dexamethasone was associated with lower mean (SD) pain scores immediately after the procedure (4.0 [3.3] vs 6.1 [3.1]; mean difference, −2.1 [95% CI, −4.14 to −0.06]) and at 96 hours (2.4 [2.4] vs 4.5 [3.2]; mean difference, −2.1 [95% CI, −3.90 to −0.30]). The mean (SE) pain score over 168 hours was lower in the dexamethasone group vs placebo (2.63 [2.28] vs 4.28 [2.27] visual analog scale units), with a mean difference of −1.64 (95% CI, −3.10 to −0.19). Overall, this study found that intraarterial dexamethasone was associated with lower postprocedural pain compared with placebo among women undergoing UFE, highlighting its potential as a low-cost strategy to reduce analgesic burden in this population.

Click here to read this study in JAMA Network Open

Image: PD

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