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Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

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Abstract

Purpose

To evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.

Materials and methods

In this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.

Results

All SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.

Conclusion

The SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

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Conflict of interest

Christoph A. Binkert MD, MBA: Merit Medical (speaker’s bureau), Florian C. Hirzel MD, Andreas Gutzeit MD, Christoph L. Zollikofer, Thomas Hess have no conflict of interest.

Informed Consent

Informed consent was obtained from all patients to use anonymized data for retrospective studies.

Statement of Human and Animal Rights

The local ethical committee approved this retrospective study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Christoph A. Binkert, Andreas Gutzeit & Christoph L. Zollikofer

  2. Department of Gynecology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Florian C. Hirzel & Thomas Hess

  3. Department of Gynecology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland

    Florian C. Hirzel

  4. Institute of Radiology, Landeskrankenhaus, Müllnerstrasse 48, 5020, Salzburg, Austria

    Andreas Gutzeit

  5. Institute of Radiology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland

    Christoph L. Zollikofer

Authors
  1. Christoph A. Binkert
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  2. Florian C. Hirzel
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  3. Andreas Gutzeit
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  4. Christoph L. Zollikofer
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  5. Thomas Hess
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Corresponding author

Correspondence to Christoph A. Binkert.

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Binkert, C.A., Hirzel, F.C., Gutzeit, A. et al. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia. Cardiovasc Intervent Radiol 38, 1157–1161 (2015). https://doi.org/10.1007/s00270-015-1118-z

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  • DOI: https://doi.org/10.1007/s00270-015-1118-z

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