Intra-arterial Lidocaine for Pain Control Post Uterine Fibroid Embolization

NCT02293447 | Completed Phase 4

• 1 other identifier: 14-8053
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Uterine artery embolization (UAE) is a minimally invasive treatment for women with symptomatic fibroids. It is similar to hysterectomy in term of satisfaction and symptoms improvement, with fewer complications and at lower cost. However, the majority of women undergoing UFE experience important pain after the procedure despite optimal analgesia, with one third reporting pain equal or worse than labor. Pain is the more common cause of prolonged hospital stay or readmission. There is need for a simple, efficient way to reduce post-procedural pain. For this prospective randomized study, the hypothesis is that an anesthetic drug, lidocaine, injected in the uterine arteries diminishes pain post-UFE. Patients will be randomized in 3 groups: control, lidocaine injected during embolization, and lidocaine injected after embolization. Pain will be evaluated using a validated scale at 4h and 24h post-intervention. Hospital length-of-stay and total narcotic dose administered will be evaluated in the three groups. This is the first Canadian study evaluating lidocaine use for pain control in UFE patients. Results will be transferable to clinical practice, considering the use of lidocaine is simple and cost is negligible. It could have a great impact on pain management in women undergoing UFE in all practice settings.

Conditions

Uterine Leiomyomas

Keywords

Uterine; Fibroid; Embolization; Leiomyoma; Lidocaine; Pain

Outcome Measures

Primary Outcomes (2)

• Post-Procedural Pain at 4 hours

  Pain will be evaluated using a validated 100mm Visual Analog Scale (VAS) filled by patients at 4h, 7h and 24h post-procedure. At 4h, patients will report the worst pain they experienced since end of procedure. At 7h and 24h, pain at time of assessment will be recorded.

  4h post-procedure

• Post-Procedural Pain at 7 hours

  Pain will be evaluated using a validated 100mm Visual Analog Scale (VAS)

  7h post-procedure

Secondary Outcomes (3)

• Hospital length-of-stay

  24 hours post-intervention

• Narcotic dose

  24 hours post-intervention

• Post-Procedural Pain at 24 hours

  24 hours post-procedure

Study Arms (3)

Control

NO INTERVENTION

The control group will undergo uterine artery embolization according to regular protocol, without the administration of lidocaine.

Lidocaine per-embolization

EXPERIMENTAL

This group will receive 10mL of 1% lidocaine in both uterine artery during the embolization; the lidocaine will be mixed with the embolization particles.

Drug: Lidocaine per-embolization

Lidocaine post-embolization

EXPERIMENTAL

10mL of 1% lidocaine will be injected in both uterine arteries after embolization endpoint is achieved.

Drug: Lidocaine post-embolization

Interventions

Lidocaine per-embolization DRUG

10mL of 1% lidocaine will be mixed with the embolization particles. Lidocaine will therefore be injected during the embolization.

Also known as: Local anesthetic, Amide-type anesthetic, Lidocaine hydrochloride, 00884154

Lidocaine per-embolization

Lidocaine post-embolization DRUG

10mL of 1% lidocaine will be injected in both uterine arteries after the embolization endpoint is achieved.

Also known as: Local anesthetic, Amide-type anesthetic, Lidocaine hydrochloride, 00884154

Lidocaine post-embolization

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Indication for uterine fibroid embolization: bulk symptoms, pain or heavy menstrual bleeding attributed to fibroids, with imaging confirmation;
• Patient must be able to provide written, informed consent

You may not qualify if:

• Documented of allergy or intolerance to lidocaine or other amide-type anesthetics;
• Personal or familial history of malignant familial hyperthermia;
• Documented history of second or third atrio-ventricular heart block
• Contra-indication to uterine fibroid embolization : active infection, suspected malignancy, coagulopathy, pregnancy or desire to preserve fertility, large pedunculated sub-serosal fibroid.
• History of previous uterine fibroid embolization.

Sponsors & Collaborators

• University Health Network, Toronto: lead

Study Sites (1)

Toronto Western Hospital

Toronto, Ontario, M5T 2S8, Canada

Location

Related Publications (24)

• Keyoung JA, Levy EB, Roth AR, Gomez-Jorge J, Chang TC, Spies JB. Intraarterial lidocaine for pain control after uterine artery embolization for leiomyomata. J Vasc Interv Radiol. 2001 Sep;12(9):1065-9. doi: 10.1016/s1051-0443(07)61592-9.

  PMID: 11535769 BACKGROUND

• Zhan S, Li Y, Wang G, Han H, Yang Z. Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine. Eur Radiol. 2005 Aug;15(8):1752-6. doi: 10.1007/s00330-005-2686-0. Epub 2005 Feb 5.

  PMID: 15696287 BACKGROUND

• Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100-7. doi: 10.1067/mob.2003.99.

  PMID: 12548202 BACKGROUND

• Pinto I, Chimeno P, Romo A, Paul L, Haya J, de la Cal MA, Bajo J. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial. Radiology. 2003 Feb;226(2):425-31. doi: 10.1148/radiol.2262011716.

  PMID: 12563136 BACKGROUND

• Hehenkamp WJ, Volkers NA, Donderwinkel PF, de Blok S, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol. 2005 Nov;193(5):1618-29. doi: 10.1016/j.ajog.2005.05.017.

  PMID: 16260201 BACKGROUND

• Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy--results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology. 2008 Mar;246(3):823-32. doi: 10.1148/radiol.2463070260. Epub 2008 Jan 9.

  PMID: 18187401 BACKGROUND

• Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11. doi: 10.1016/j.ajog.2007.02.029.

  PMID: 17547877 BACKGROUND

• Ananthakrishnan G, Murray L, Ritchie M, Murray G, Bryden F, Lassman S, Lumsden MA, Moss JG. Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings. Cardiovasc Intervent Radiol. 2013 Jun;36(3):676-81. doi: 10.1007/s00270-012-0485-y. Epub 2012 Oct 16.

  PMID: 23070101 BACKGROUND

• Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, Murray GD; Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70. doi: 10.1056/NEJMoa062003.

  PMID: 17251532 BACKGROUND

• Moss JG, Cooper KG, Khaund A, Murray LS, Murray GD, Wu O, Craig LE, Lumsden MA. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011 Jul;118(8):936-44. doi: 10.1111/j.1471-0528.2011.02952.x. Epub 2011 Apr 12.

  PMID: 21481151 BACKGROUND

• Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 2013 Dec;30(4):354-63. doi: 10.1055/s-0033-1359729.

  PMID: 24436562 BACKGROUND

• Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K; Ontario Uterine Fibroid Embolization Collaboration Group. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril. 2003 Jan;79(1):120-7. doi: 10.1016/s0015-0282(02)04538-7.

  PMID: 12524074 BACKGROUND

• Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG. 2002 Nov;109(11):1262-72. doi: 10.1046/j.1471-0528.2002.01449.x.

  PMID: 12452465 BACKGROUND

• van der Kooij SM, Moolenaar LM, Ankum WM, Reekers JA, Mol BWJ, Hehenkamp WJK. Epidural analgesia versus patient-controlled analgesia for pain relief in uterine artery embolization for uterine fibroids: a decision analysis. Cardiovasc Intervent Radiol. 2013 Dec;36(6):1514-1520. doi: 10.1007/s00270-013-0607-1. Epub 2013 Apr 11.

  PMID: 23576212 BACKGROUND

• Rasuli P, Jolly EE, Hammond I, French GJ, Preston R, Goulet S, Hamilton L, Tabib M. Superior hypogastric nerve block for pain control in outpatient uterine artery embolization. J Vasc Interv Radiol. 2004 Dec;15(12):1423-9. doi: 10.1097/01.RVI.0000137406.09852.A4.

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• Guthaner DF, Silverman JF, Hayden WG, Wexler L. Intraarterial analgesia in peripheral arteriography. AJR Am J Roentgenol. 1977 May;128(5):737-9. doi: 10.2214/ajr.128.5.737.

  PMID: 404894 BACKGROUND

• Widrich WC, Singer RJ, Robbins AH. The use of intra-arterial lidocaine to control pain due to aortofemoral arteriography. Radiology. 1977 Jul;124(1):37-41. doi: 10.1148/124.1.37.

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• Widrich WC, Robbins AH, Goldstein SA, Singer RJ. Adjuvant intra-arterial lidocaine in aortofemoral arteriography: some further observations. Radiology. 1978 Nov;129(2):371-3. doi: 10.1148/129.2.371.

  PMID: 360272 BACKGROUND

• Cranston PE. Lidocaine analgesia in peripheral angiography: a confirmation of effectiveness. South Med J. 1982 Oct;75(10):1229-31. doi: 10.1097/00007611-198210000-00018. No abstract available.

  PMID: 7123294 BACKGROUND

• Gordon IJ, Westcott JL. Intra-arterial lidocaine: an effective analgesic for peripheral angiography. Radiology. 1977 Jul;124(1):43-5. doi: 10.1148/124.1.43.

  PMID: 866655 BACKGROUND

• Molgaard CP, Teitelbaum GP, Pentecost MJ, Finck EJ, Davis SH, Dziubinski JE, Daniels JR. Intraarterial administration of lidocaine for analgesia in hepatic chemoembolization. J Vasc Interv Radiol. 1990 Nov;1(1):81-5. doi: 10.1016/s1051-0443(90)72508-0.

  PMID: 1966862 BACKGROUND

• Hartnell GG, Gates J, Stuart K, Underhill J, Brophy DP. Hepatic chemoembolization: effect of intraarterial lidocaine on pain and postprocedure recovery. Cardiovasc Intervent Radiol. 1999 Jul-Aug;22(4):293-7. doi: 10.1007/s002709900391.

  PMID: 10415218 BACKGROUND

• Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth. 2008 Jul;101(1):17-24. doi: 10.1093/bja/aen103. Epub 2008 May 16.

  PMID: 18487245 BACKGROUND

• Pron G, Mocarski E, Bennett J, Vilos G, Common A, Zaidi M, Sniderman K, Asch M, Kozak R, Simons M, Tran C, Kachura J; Ontario UFE Collaborative Group. Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. J Vasc Interv Radiol. 2003 Oct;14(10):1243-50. doi: 10.1097/01.rvi.0000092664.72261.f9.

  PMID: 14551270 BACKGROUND

Related Links

• UHN research ethics board contact information

MeSH Terms

Conditions

Myofibroma; Leiomyoma; Pain

Interventions

Anesthetics, Local; Lidocaine

Condition Hierarchy (Ancestors)

Neoplasms, Connective Tissue; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Neoplasms, Muscle Tissue; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthetics; Central Nervous System Depressants; Physiological Effects of Drugs; Pharmacologic Actions; Chemical Actions and Uses; Sensory System Agents; Peripheral Nervous System Agents; Central Nervous System Agents; Therapeutic Uses; Acetanilides; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Officials

• Dheeraj Rajan, MD, FRCPC

  University Health Network, Toronto

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Attending Interventional Radiologist and Associate Professor

Study Record Dates

• First Submitted: November 10, 2014
• First Posted: November 18, 2014
• Study Start: November 1, 2014
• Primary Completion: March 1, 2016
• Study Completion: March 1, 2016
• Last Updated: May 12, 2016

Record last verified: 2016-05

Locations

CA (1)