Superior Hypogastric Nerve Block Research Articles

Abstract No. 389 - Superior hypogastric nerve block for pain control in uterine fibroid embolization

No. 388 VIR DIRECT pathway: survey of graduates and trainees from this pilot IR training program L. Nissim, E. Krupinski; Radiology, University of Arizona, Scottsdale, AZ Purpose: The Vascular/Interventional Radiology Diagnostic and Interventional Radiology Enhanced Clinical Training (“VIR DIRECT” or “DIRECT”) Pathway is a pilot training pathway designed for graduating medical students interested in focused training in Interventional Radiology (IR). The goal of this study is to assess the current and former DIRECT trainees in terms of their IR skills, ability to attain certification, and success in establishing a post-training career in IR. Materials and Methods: An anonymous web-based survey was developed and sent to all current and past VIR DIRECT participants to assess their perceptions regarding the impact of the DIRECT pathway on their training and practice of IR and diagnostic radiology. Results: The majority of respondents (72.5%) rated their overall IR skills as better than graduates of the traditional IR fellowship, including when asked to self-assess their ability in specific IR procedures. While comments submitted by respondents suggest some challenges with their non-traditional training, most (70%) said they did not have difficulty preparing for Diagnostic Radiology board examination and the majority (92%) passed on the first attempt. No graduates reported experiencing a bias against their hiring due to their non-traditional pathway and 55% of graduates said they experienced a bias in favor of them. Conclusion: Enrollees in the VIR DIRECT pathway have faired comparably well in terms of their training and careers in IR, and in some instance perceive their IR skills as greater than traditional trainees. Graduates of the program have also been successful in attaining Diagnostic Radiology board certification. This information may be useful in forecasting the success of the imminent dual certificate DR/IR residency in achieving

Clinical and Periprocedural Pain Management for Uterine Artery Embolization

Uterine artery embolization has Level A data supporting excellent safety and efficacy in treating symptomatic uterine leiomyomata. However, there is a perception that either postprocedural pain is severe or poorly managed by the physician performing these procedures. This has led some primary care physicians to omit this procedure from the patients' options or to steer patients away from this procedure. A few simple techniques (pruning of the vascular tree and embolizing to 5-10 beat stasis) and fastidious pre-, intra-, and post-procedural management can nearly eliminate significant pain associated with embolization. Specifically, early implementation of long-acting low-dose narcotics, antiemetics and anti-inflammatory medications is critical. Finally, the use of a superior hypogastric nerve block, which takes minutes to perform and carries a very low risk, significantly reduces pain and diminishes the need for narcotics; when this technique was used in a prospective study, all patients were able to be discharged the day of the procedure. In the authors' experience, patients treated in this manner largely recover completely within 5 days and have a far less traumatic experience than patients traditionally treated with only midazolam (Versed) and fentanyl citrate (fentanyl) intraprocedurally, and narcotics and nonsteroidal antiinflammatory drugs postprocedurally.

Superior Hypogastric Nerve Block for Pain Control in Outpatient Uterine Artery Embolization

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. 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. 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). 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.

Superior hypogastric nerve block for pelvic pain

Opioids have been used for a long period in the treatment of pelvic pain. Patients often develop tolerance to opioids or experience unpleasant side effects, necessitating discontinuance. Superior hypogastric plexus nerve block with neurolytic agents may be useful in these patients and also may help in reducing mean opioid consumption in many other patients. Published studies have established that superior hypogastric nerve blocks can significantly reduce visual analog pain scores in patients and/or decrease their opioid intake. Superior hypogastric plexus is located bilaterally at the level of the lower third of the fifth lumbar vertebral body and upper third of the first sacral vertebral body at the sacral promontory, in which it is blocked under fluroscopic guidance. Therefore, this procedure, when performed properly, could help treat patients with chronic pelvic pain, resulting in minimal side effects. Copyright © 2001 by W.B. Saunders Company