ArticleHealth science reports2026
Pain Trajectories and Predictors Following Uterine Artery Embolization Using a Nitroglycerin-Lidocaine Protocol: A Prospective Study.
Article in Health science reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Uterine artery embolization (UAE) is an effective minimally invasive treatment for symptomatic fibroids; however, post-procedural pain remains a major limitation. Intra-arterial lidocaine administration has shown inconsistent results with concerns regarding vasospasm and incomplete embolization. We addressed this by introducing a sequenced protocol utilizing prophylactic intra-arterial nitroglycerin. This study aimed to characterize post-procedural pain trajectories, identify predictors of pain severity, and evaluate the safety of the regimen. Methods: In this prospective single-arm study, 34 women with symptomatic uterine fibroids underwent UAE between April and August 2025. To prevent vasospasm, 100 µg of intra-arterial nitroglycerin was administered into each uterine artery before embolization. Embolization was then performed to near-stasis, after which 2 mL of 1% lidocaine (20 mg per uterine artery) diluted to 4 mL was infused intra-arterially. Pain intensity was recorded using the Visual Analog Scale (VAS) at baseline and at 1, 2, 3, 6, 12, and 24 h post-procedure. Associations between fibroid characteristics and pain were analyzed using correlation analysis. Results: All procedures were technically successful without complications or vasospasm. The mean patient VAS score peaked at 3 h (6.24 ± 1.67) and gradually declined thereafter. The volume of the largest fibroid correlated positively with mean pain ( Conclusion: The volume of the largest uterine fibroid was associated with greater post-UAE pain. Prophylactic intra-arterial nitroglycerin administered before embolization allowed subsequent intra-arterial lidocaine administration without observed vasospasm. Larger randomized trials are needed to further evaluate and optimize this analgesic approach.
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