Pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) after uterine artery embolization for symptomatic myomatosis

Abstract

Introduction:Severe pelvic pain is the most common adverse effect after uterine artery embolization (UAE) for symptomatic myomas. The aim of this case series is to describe pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) in patients treated with UAE for symptomatic myomas. Material and Methods: We present a case series of women with symptomatic uterine myomas treated with UAE and ultrasound-guided SHPB. The visual analog scale (VAS) was used to assess pelvic pain with a rating of minimal (0-2), moderate (3-7), and severe (8-10). The initial VAS was recorded immediately after UAE, and the final VAS twelve to fourteen hours after SHPB and before discharge. Results: Eighteen cases of ultrasound-guided SHPB after UAE were included. A gelatin sponge was used for embolization in 16 women and polidocanol (3%) was added in two cases. Ultrasonographic-guided SHPB was performed with a Chiba 16-gauge needle in 14 patients and a 22-gauge in four cases. The adequate needle tip placement in the anterior wall of L5 was confirmed by fluoroscopy. The mean age of the women was 40.38 ± 7.6 years. The mean initial VAS was mild (1.2 ± 2.2) similar to the final VAS (2.5 ±1.8). The mean number of myomas was 2.4 ± 1.6, and the mean uterine volume was 811.5 ± 599.04 mL. The relevant aspects of the UAE and ultrasound-guided SHPB of specific cases are presented. Conclusion: This report is the first to demonstrate the efficacy of ultrasound-guided SHPB for managing pelvic pain after UAE in patients with symptomatic myomas.