Preemptive Analgesia Following Uterine Artery Embolization

Uterine leiomyomata, also known as fibroids, are an extremely common benign lesion being
present in 30-50% of all women. Traditional surgical treatment of symptomatic fibroids has
been hysterectomy in post child bearing woman. However, over the last decade, the use of a
minimal invasive technique called uterine artery embolization has become increasingly
popular due to high patient satisfaction, cost effectiveness, and shorter recovery period.
The purpose of this randomized blinded placebo controlled study is to compare pre-emptive
analgesia vs non-preemptive analgesia for immediate postoperative pain control, long term
pain control, and improved quality of life in woman following uterine artery embolization
surgery. The study consists of four drug groups including a placebo group. The addition of
pregabalin and celecoxib together with epidural analgesia may improve pain management as
well as leading to a better post-procedure outcome in women following uterine artery
embolization.

Many investigators believe that the ischemia in the normal myometrium is the primary source
of pain immediately following surgery making postoperative pain management challenging.
Epidural fentanyl may offer an advantage when encountering visceral pain. In addition to
being an effective analgesic for chronic pain syndromes, the use of pregabalin provides
effective postoperative analgesia when it is administered pre-emptively before an operation.
Preemptive analgesia involves the introduction of an analgesic regimen before the onset of
noxious stimuli, with the goal of preventing sensitization of the nervous system to
subsequent stimuli that could amplify pain. In human trials, pregabalin has been
demonstrated to reduce pain, improve sleep, and mood disturbances in patients with post
herpetic neuralgia. The use of celecoxib in combination with pregabalin has shown to provide
more effective analgesia by providing antihyperalgesia. Therefore, the addition of
pregabalin and celecoxib together with epidural analgesia may improve pain management as
well as having an effect on long term sequelae.