Abstract No. 433 Trans-radial uterine artery embolization with the superior hypogastric nerve block: optimizing pain control and minimizing length of stay

Abstract

We aim to describe our experience using the trans-radial approach and the superior hypogastric nerve block in performing outpatient uterine artery embolization, focusing on postprocedure narcotic requirements and the time to discharge. We reviewed the records of all outpatients who underwent trans-radial uterine artery embolization (UAE) with a superior hypogastric nerve block (SHNB) between April 2014 and August 2017. We perform trans-radial UAE and the SHNB in a manner similar to that which has been described1′2 excepting that we administer 20 ml of 0.5% bupivacaine anterior to the L5 vertebral body. Time required to perform the SHNB was measured as the time elapsed between the final post-embolization arteriogram and the last image documenting needle tip location for the nerve block. The postprocedural time to discharge was captured as the time between the last procedural image recorded and the later of the last set of vital signs or the time discharge instructions were printed. Additionally, we recorded narcotic administration intra- and postprocedure. We also noted patients admitted directly from recovery and those who re-presented for symptom control after discharge. Seventy-nine outpatients underwent trans-radial UAE with the SHNB. Bilateral trans-radial UAE was technically successful in 76 of 78 patients; the SHNB was successful in all but one patient. Average procedure time for the nerve block was 7 m 31s (range, 2 to 33 m). Five patients were admitted from the postprocedure area for pain or nausea control, and one patient was admitted for bleeding. 37 of 78 patients required no narcotic medications in the postprocedural setting. Median time to discharge was 2h 37 m (n = 72, range 0:25 to 6:45). Of these patients, six re-presented within five days for uncontrolled pain or nausea. The trans-radial approach combined with a superior hypogastric nerve block can minimize narcotic use and time to discharge when performing outpatient uterine artery embolization.