E2457. Superior Hypogastric Nerve Blockade to Reduce Pain After Uterine Fibroid Artery Embolization: A Systematic Review
Authors
Arif Musa;
ProMedica Monroe Regional Hospital
El Caney Arnold IV;
Las Palmas Del Sol Medical Center
Rhett Carpenter-Thompson;
St. Mary's Mercy Livonia Hospital
Ramon Ter-Oganesyan;
University of Southern California Keck Hospital
Monte Harvill;
Detroit Medical Center
Roger Kakos;
Children's Hospital of Michigan; Detroit Medical Center
Ali Harb;
Detroit Medical Center
Objective:
Uterine fibroid embolization (UFE) is a minimally invasive treatment of fibroids in women with symptoms such as pain, menorrhagia, and dysmenorrhea. However, post-procedural pain after UFE often requires opiate use and has the potential to increase length of stay, readmission, and complications. The superior hypogastric nerve blockade (SHNB) has been proposed as a means to reduce pain after UFE. This study was performed to evaluate the current evidence on the use of SHNB to reduce pain after UFE.
Materials and Methods:
A systematic review of SHNB in UFE was performed. The following databases were searched: PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, World Health Organization Clinical Trials Database, and databases of the Society of Interventional Radiology and Cardiovascular and Interventional Radiology Society of Europe. Results were screened according to predetermined inclusion and exclusion criteria. Studies included were clinical trials, observational studies, and case reports. Outcomes analyzed were technical success, time to complete SHNB, time under fluoroscopic guidance, time to complete procedure, time to recovery, needle repositioning, discharge on same-day, readmission, post-procedural pain, adverse events, and analgesic consumption. Standardized reporting guidelines were used to report findings of the study.
Results:
A total of 16 studies were analyzed. Overall, technical success was 98.8% for SHNB in UFE. On average, the time to complete SHNB was 7.7 minutes, time under fluoroscopic guidance was 13.3 minutes, time to complete the procedure was 106.0 minutes, and time to recovery was 184.6 minutes. Needle repositioning occurred an average of 1.2 times. Discharge rates on the same day were 99.0% and readmission rates were 6.9%. The average post-procedural pain score was 3.4/10. The rate of adverse events was 0.4% and 46.7% of patients did not require additional analgesics after SHNB.
Conclusion:
SHNB offers an efficient means of reducing pain following UFE without substantially increasing procedure time, time under fluoroscopy, or adverse events. SHNB appears to allow for same-day discharge without greatly increasing readmission rates.
