title: Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia.
abstract: OBJECTIVE
  To evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.
  
  
  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.
  
  
  CONCLUSIONS
  The SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.
authors.affiliation: Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. christoph.binkert@ksw.ch.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Binkert
authors.affiliation: Department of Gynecology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.|Department of Gynecology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland.
authors.forename: Florian C
authors.initials: FC
authors.lastname: Hirzel
authors.affiliation: Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.|Institute of Radiology, Landeskrankenhaus, Müllnerstrasse 48, 5020, Salzburg, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gutzeit
authors.affiliation: Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.|Institute of Radiology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland.
authors.forename: Christoph L
authors.initials: CL
authors.lastname: Zollikofer
authors.affiliation: Department of Gynecology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hess
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000187:drug effects*; D009407:Nerve Block; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects*
keywords: Embolization/embolisation/embolotherapy; Fibroid; Pain management; Uterine artery embolization/embolisation; Uterine fibroid