Superior hypogastric nerve block for pain control in outpatient uterine artery embolization.
OBJECTIVE
To assess the efficacy of the superior hypogastric nerve block (SHNB) in permitting uterine artery embolization (UAE) to be performed as a routine outpatient procedure.


METHODS
One hundred thirty-nine patients who underwent UAE in a prospective single-arm clinical trial in an academic institution underwent SHNB from an anterior abdominal approach to control acute postprocedural pain, in addition to conventional conscious sedation. They were discharged and prescribed one of two drug combinations started during the in-hospital recovery period. Regimen A included short-acting morphine tablets and indomethacin rectal suppositories and regimen B included long-acting morphine tablets for baseline pain supplemented with short-acting morphine tablets for breakthrough pain, and naproxen rectal suppositories. All patients were contacted by phone on the third and fifth postprocedural days and their peak pain experience was recorded on a scale of 0 to 10.


RESULTS
All patients were able to be discharged the day of the procedure. Seven patients (5%) returned to the hospital because of pain. One was discharged after undergoing a second SHNB and four were discharged after receiving intravenous analgesics; two required longer admission for intravenous analgesia. The mean (+/-SD) peak pain score in the first 5 days after the procedure for all patients was 4.8 +/- 2.6. There was a significant difference between regimens A (mean pain score, 5.7 +/- 2.2) and B (mean pain score, 2.7 +/- 2.5; Mann-Whitney, 5.94; P < .01).


CONCLUSIONS
The addition of SHNB to the more conventional post-UAE pain management methodology enhances pain control, enabling the procedure to be offered with minimum pain on a routine outpatient basis.
Rasuli
Pasteur
P
Department of Radiological Imaging, Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6. prasuli@rogers.com
Jolly
Elaine E
EE
Hammond
Ian
I
French
Gordon J
GJ
Preston
Roanne
R
Goulet
Sally
S
Hamilton
Linda
L
Tabib
Mohamed
M
D000328:Adult; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D018709:Statistics, Nonparametric; D014594:Uterine Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*