Superior Hypogastric Nerve Block as Post–Uterine Artery Embolization Analgesia: A Randomized and Double-Blind Clinical Trial

Abstract

Purpose To evaluate the effectiveness of superior hypogastric nerve block (SHNB) in reducing narcotic use after uterine artery embolization (UAE). Materials and Methods This study was a prospective, randomized, double-blind, parallel clinical trial in patients referred to a tertiary care university teaching hospital for UAE. Forty-four participants were enrolled (mean age, 46 years; range, 32-56 years). No consenting patient was excluded. All participants were randomized 1:1 to undergo either a sham procedure or SHNB. There were 22 participants in each group. One participant was lost to follow-up regarding home survey results. Use of narcotics and antiemetics was recorded in-hospital. Pain scores were recorded at home for 10 days with use of a visual analog scale (range, 1-10). Statistical analysis was performed by using the t test and χ test, with P < .05 considered indicative of a statistically significant difference. The full study protocol can be found at www.clinicaltrials.gov (NCT02270255). Results Participant demographic characteristics, fibroid volume, symptoms, and perceived sensitivity to pain were similar in both groups. Immediately after embolization, the pain score was lower in the SHNB group than in the sham group (mean, 1.0 ± 2.1 vs 2.6 ± 2.0, respectively; P = .01). The total need for fentanyl in the postanesthesia care unit was lower in the SHNB group than in the sham group (mean, 56 μg ± 67 vs 124 μg ± 91, respectively; P = .009). The morphine-equivalent dose needed was lower in the SHNB group than in the sham group (mean, 5.1 mg ± 5.8 vs 11.0 mg ± 9.0, respectively; P = .014). Of the 22 participants in the SHNB group, five (23%) needed antiemetics versus 12 of 22 participants (55%) in the sham group (P = .03). No difference in hospital admissions was observed between the two groups, and no major complications occurred from the SHNB. Conclusion Use of superior hypogastric nerve block reduces the amount of pain-related narcotics and antiemetics after uterine artery embolization. © RSNA, 2018.

Efficacy of Intraprocedural Superior Hypogastric Nerve Block in Reduction of Postuterine Artery Embolization Narcotic Analgesia Use

“…Yoon et al recently published a randomized, double-blind clinical trial study demonstrating that the use of SHNB reduces the amount of pain-related narcotics after UAE compared to no nerve block. 10 However, this study only compared the need for narcotic analgesia during the 4-hour observation period in the postanesthesia care unit, and the majority of study participants were discharged home on the same of the procedure with oral pain medications to be taken as needed. In our study, the use of postprocedural narcotic analgesia was compared for the duration of overnight inhospital observation, which captures the entire period of typical progression of post-UAE pain peaking around 7 to 12 hours after the procedure.…”

Management of Postprocedural Uterine Artery Embolization Pain

“…29 Although SHNB has been shown to be less effective at reducing pain relative to epidural anesthesia, a recent double-blind randomized control trial showed SHNB to significantly lower mean postprocedural pain scores immediately after UAE, opiate use, and antiemetics with no major complications as compared with a sham procedure. 13,30 Of note, pain reduction compared with the sham procedure was not significant on arrival at the post-anesthesia care unit (PACU), or at departure from the PACU (►Table 2). 13 Finally, SHNB was also shown to decrease the amount of post-procedural morphine used when compared with no SHNB by 47.2% (►Table 2).…”

“…Over the next 2 to 3 days, the pain is usually of low level finally subsiding by 7 to 10 days. [11][12][13] There have been attempts to predict a patient's postprocedural pain severity using baseline uterine or fibroid volume; however, the results have not been significant. 14 Managing patient expectations through preprocedural counseling on the time course and management of post-UAE pain can help better shape a patient's understanding of their experience and may allay anxieties associated with the unexpected.…”

Initial experience with HydroPearl microspheres for uterine artery embolization for the treatment of symptomatic uterine fibroids

“…A 5-Fr vertebral catheter was advanced over a guidewire and positioned just above the aortic bifurcation, and an aortogram was performed in order locate the iliac arteries. A superior hypogastric nerve block was then performed for post-procedure pain control, as described in the literature, at the level of either L4 or L5 depending on the patient's arterial anatomy (Yoon et al, 2018). The 5-Fr catheter was then advanced into the uterine artery, and digital subtraction angiography was performed.…”