Severe Pain in a Leiomyoma with Twin Pregnancy- An Analgesic Dilemma

BACKGROUND: Pain is the most common complication of fibroids in pregnancy and can be difficult to treat. The choices of pain relief in pregnancy are limited due to myriad risks including miscarriage, teratogenicity, premature birth, and low birth weight.CASE REPORT: This paper describes the analgesic challenges faced when managing severe pain in the antepartum period for a woman pregnant with twins who also suffered from uterine leiomyomas. Multiple analgesic regimens were trialled over the course of the pregnancy with large doses of opioids required for long periods. Ultimately the patient underwent a laparotomy and myomectomy at 25 weeks gestation in an attempt to alleviate her pain.CONCLUSION: There should be early discussions and planning around the choice of analgesic agents and their planned duration, with the risks and benefits weighed in each instance. A multidisciplinary approach with obstetricians, neonatologists, anesthetists, and pain specialists is likely to result in the most benefit while limiting the risk to the fetus