RESUMO
In a single-arm, nonrandomized, retrospective case-control study, 39 patients (mean age, 44 y) who underwent elective outpatient uterine artery embolization with the use of superior hypogastric nerve block (SNHB) for pain control over a period of 3 years were identified. Technical success of SNHB was 87%. Of the 34 patients who received SNHB, 97% did not need a patient-controlled analgesia pump. The median opioid requirement for the 17 patients who needed opioid agents was 7.5 morphine milligram equivalents (interquartile range [IQR], 10). The median length of stay was 2.2 hours (IQR, 1.7 h). SHNB offers a safe and effective intervention that significantly reduces pain and the need for opiate agents and allows same-day discharge after uterine artery embolization.
Assuntos
Plexo Hipogástrico , Leiomioma/terapia , Tempo de Internação , Bloqueio Nervoso , Dor/prevenção & controle , Alta do Paciente , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Bloqueio Nervoso/efeitos adversos , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Neoplasias Uterinas/diagnóstico por imagemAssuntos
Amidas/efeitos adversos , Anestésicos Locais/efeitos adversos , Plexo Hipogástrico , Leiomioma/cirurgia , Bloqueio Nervoso/efeitos adversos , Síndromes Neurotóxicas/etiologia , Dor Pós-Operatória/prevenção & controle , Embolização da Artéria Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia , Amidas/administração & dosagem , Anestésicos Locais/administração & dosagem , Aortografia , Emulsões Gordurosas Intravenosas/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/tratamento farmacológico , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Ropivacaina , Resultado do TratamentoRESUMO
BACKGROUND: Superior Hypogastric nerve Block (SHNB) has been shown to be an effective pain management technique after Uterine Fibroid Embolization (UFE), reducing the need for opiates and allowing same-day discharge after UFE. In this technical note we discuss relevant anatomy and technical details in performing SHNB. MAIN BODY: The Superior hypogastric plexus (SHP) is the part of the abdominopelvic sympathetic nervous system that provides a targeted intervention to sympathetic-mediated pain pathways of pelvic organs and a target for an anterior approach Superior Hypogastric nerve Block after embolization. Vascular structures are in close relation to the intended site of target of the SHP at the L5 vertebral body include aortic bifurcation and IVC confluence, hence a detailed knowledge of this is essential. A step by step technical approach to SHNB includes patient positioning for the block, image guidance and needle positioning, choice and technique of anesthetic injection. Traversing a large fibroid uterus, inadvertent vascular opacification and Local anesthetic systemic toxicity present challenges to performing the block and are addressed. CONCLUSION: Superior Hypogastric nerve Block (SHNB) can be a useful tool in the Interventional armamentarium to make UFE a better experience for patients with fibroids, allowing for better pain control as well as facilitating same day discharge. Performing SHNB appear to be can be performed with technical ease for an interventional radiologist.