089 - Superior Hypogastric Nerve Blockade to Reduce Pain After Uterine Fibroid Artery Embolization: A Systematic Review
El caney Arnold, M.D. – Transitional Year Resident, Las Palmas Del Sol Medical Center; Rhett Carpenter-Thompson, M.D. – Transitional Year Resident, St. Mary Mercy Hospital; Arash Anavim, M.D., M.B.A. – Vice Chair, Radiology, University of California Irvine School of Medicine; Ramon Ter-Oganesyan, M.D. – Assistant Professor, Radiology, University of Southern California Keck School of Medicine; Monte Harvill, M.D. – Assistant Professor, Wayne State University / Detroit Medical Center; Roger Kakos, M.D. – Assistant Professor, Radiology, Wayne State University / Detroit Medical Center; Russell Salamo, M.D. – Radiology Resident, Radiology, University of Southern California Keck School of Medicine; Trevor Carle, M.D. – Resident, Radiology, University of Southern California Keck School of Medicine; Ali Harb, M.D. – Diagnostic Radiology Program Director, Radiology, Wayne State University / Detroit Medical Center
Purpose: Women with symptomatic uterine fibroids may experience pain, menorrhagia, and dysmenorrhea among other symptoms. One minimally invasive option to treat symptomatic fibroids is uterine artery embolization (UAE). However, post-procedural pain after UAE has been linked to increased length of stay, readmission rates, and complications. The superior hypogastric nerve blockade (SHNB) has been suggested as adjunct to relieve pain following UAE. This study was performed to evaluate the effectiveness of SHNB in UAE procedures.
Material and Methods: This was a comprehensive, systematic review of human studies and articles. A search strategy was developed and implemented for the following databases: PubMed, Cochrane Library, Web of Sciences, Clinicaltrials.gov, the World Health Organization Clinical Trials Database, and online abstracts from the meetings of the Society of Interventional Radiology (SIR) and Cardiovascular and Interventional Radiology Society of Europe (CIRSE). Eligible studies were screened according to inclusion-exclusion criteria established a priori. Data were abstracted for technical success, time to complete SHNB, time under fluoroscopy, time to complete UAE, time to recovery, needle reposition, same-day discharge, readmission, post-procedural pain, adverse events, and analgesic use. Standardized reporting guidelines were used to document results.
Results: A total of 16 articles met criteria for inclusion. The technical success rate was 98.8% for SHNB in UAE. On average, time to complete SHNB was 7.7 minutes, time under fluoroscopy was 13.3 minutes, time to complete UAE was 106.0 minutes, and time to recovery was 184.6 minutes. The needle was repositioned 1.2 times on average. Same-day discharge occurred in 99.0% of cases and readmission occurred in 6.9% of cases. The average post-procedural pain score was 3.4. Adverse events were rare (0.4%). Of patients that underwent SHNB, 46.7% did not use additional analgesics.
Conclusions: This systematic review of the literature found that SHNB appears to reduce post-procedural pain and analgesic use after UAE. Technical success rates were high, readmission rates were low, and there were few adverse events. SHNB did not substantially prolong procedure length. Future, high-quality randomized controlled trials are needed to compare patients undergoing SHNB in UAE procedures to patients solely undergoing UAE to confirm outcomes.
