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Musa A, Arnold EC, Carpenter-Thompson R, Anavim A, Ter-Oganesyan R, Harvill ML, Kakos R, Salamo R, Carle T, Harb A. Superior Hypogastric Nerve Blockade for Uterine Artery Embolization: A Systematic Review. J Vasc Interv Radiol 2023; 34:1827-1834.e2. [PMID: 37343665 DOI: 10.1016/j.jvir.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Superior hypogastric nerve block (SHNB) has potential to reduce pain following uterine artery embolization (UAE). However, existing studies are limited by design, sample size, or conflicting results. A systematic review of the literature was performed. Outcomes included technical success, time to complete SHNB, time under fluoroscopy, procedure time, time to recovery, needle repositioning, same-day discharge, readmission, pain, analgesic consumption, and adverse events. Of 15 included studies, the same-day discharge rate was 98.8%, and readmission rate was 6.9%. The mean pain score was 3.4 in patients who received SHNB compared to 4.3 among controls. Of patients who received SHNB, 46.7% did not require further pain medication. Major adverse events occurred in 0.4% of patients. Early clinical studies suggest that SHNB appears to reduce pain and analgesic consumption in patients undergoing UAE. Additional randomized trials are needed to confirm these findings.
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Affiliation(s)
- Arif Musa
- Transitional Year Residency Program, ProMedica Monroe Regional Hospital, Monroe, Michigan.
| | - El Caney Arnold
- Transitional Year Residency Program, H.C.A. Las Palmas Del Sol Healthcare, El Paso, Texas
| | | | - Arash Anavim
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Ramon Ter-Oganesyan
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Monte L Harvill
- Department of Radiology, Detroit Medical Center/Wayne State University School of Medicine, Michigan
| | - Roger Kakos
- Department of Radiology, Detroit Medical Center/Wayne State University School of Medicine, Michigan
| | - Russell Salamo
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Trevor Carle
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Ali Harb
- Department of Radiology, Detroit Medical Center/Wayne State University School of Medicine, Michigan
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Chan P, Garcia-Reyes K, Cronan J, Newsome J, Bercu Z, Majdalany BS, Resnick N, Gichoya J, Kokabi N. Managing Postembolization Syndrome-Related Pain after Uterine Fibroid Embolization. Semin Intervent Radiol 2021; 38:382-387. [PMID: 34393350 DOI: 10.1055/s-0041-1731406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patricia Chan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kirema Garcia-Reyes
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Julie Cronan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Neil Resnick
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Judy Gichoya
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Souftas V, Deuteraiou D, Anthoulaki X, Chalkidou A, Bothou A, Gaidatzi F, Tsypsianis G, Iatrakis G, Zervoudis S, Souftas D, Michalopoulos S, Vogiatzaki T, Galazios G, Nikolettos N, Tsikouras P. Significance of changes in inflammatory parameters following uterine artery embolization in pre-menopausal females. Exp Ther Med 2020; 19:3684-3690. [PMID: 32346432 PMCID: PMC7185183 DOI: 10.3892/etm.2020.8652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022] Open
Abstract
The purpose of the present study was to describe the course of changes in laboratory inflammatory markers following bilateral uterine artery embolization (UAE) as a treatment for leiomyomas and adenomyosis. The body temperature was measured and blood samples were collected to determine white blood cell (WBC) count and C-reactive protein (CRP) levels in 270 patients on the day prior to UAE and for up to 4 days post-embolization. Aside from a single case with a non-inflammatory complication, none of the other cases had any complications. Post-UAE leukocytosis with a mean maximum value of 10.8±3.5x109/l (range, 5.9-18.6x109/l) was observed one-year post-intervention. The mean leukocyte numbers were indicated to be higher on day 3 post-UAE. The CRP level was also increased post-UAE, with a mean maximum value of 7.75±3.5 mg/dl. Maximum levels were reached in 8 patients on the 2nd and in 11 patients on the 3rd post-operative day. The maximum pain score was ~5.5 and reached its lowest level at the end of the 12th week post-intervention. The present study did not consider an association between the embolic material used or uterus size with the level of treatment success. No complications were observed post-UAE; however, a significant increase in the WBC count was observed within the first 3 days, indicating mild leukocytosis.
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Affiliation(s)
- Vasileios Souftas
- Department of Interventional Radiology and Medical Imaging, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Dorelia Deuteraiou
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Anastasia Bothou
- Department of Obstetrics and Mastology, Rea Hospital, Athens 17564, Greece
| | - Fotini Gaidatzi
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Grigorios Tsypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Georgios Iatrakis
- University of West Attica, Department of Midwifery, Athens 17564, Greece
| | - Stefanos Zervoudis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Dimitrios Souftas
- Department of Social Administration, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Spyridon Michalopoulos
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Theodosia Vogiatzaki
- Department of Anesthesiology and Pain Treatment, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - George Galazios
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
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Cashman JN, Ng L. The management of peri- and postprocedural pain in interventional radiology: a narrative review. Pain Manag 2017; 7:523-535. [DOI: 10.2217/pmt-2017-0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Interventional radiology encompasses a wide range of procedures and the degree of associated pain depends predominantly on the procedure being undertaken. Procedures may be painful during but not after the procedure, relatively painless during but painful after the procedure, or relatively painless during and after the procedure. However, there is a lack of good quality publications in interventional radiology that specifically address the subject of peri- and postprocedural pain management. Nevertheless, a variety of more or less complex protocols exist for intraprocedural sedation and for peri- and postprocedural analgesia. While weight-based protocols for procedural sedation have demonstrable benefit, protocols for postprocedural pain relief after major procedures have not been sufficiently rigorously evaluated.
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Affiliation(s)
- Jeremy N Cashman
- Department of Anaesthetics, St George's Hospital, Blackshaw Road, London SW17 0QT, England
| | - Lenny Ng
- Department of Anaesthetics, St George's Hospital, Blackshaw Road, London SW17 0QT, England
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Bédouet L, Moine L, Servais E, Beilvert A, Labarre D, Laurent A. Tunable delivery of niflumic acid from resorbable embolization microspheres for uterine fibroid embolization. Int J Pharm 2016; 511:253-261. [DOI: 10.1016/j.ijpharm.2016.06.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/28/2016] [Indexed: 12/01/2022]
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Zhao JB, Luo ZL, Feng C, Zeng QL, He XF, Li YH, Chen Y. Effects of the intermittent injection with super-low pressure on the postoperative pain control during the uterine artery embolization for uterine myoma. Int J Clin Exp Med 2015; 8:14303-14307. [PMID: 26550414 PMCID: PMC4613099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Uterine artery embolization (UAE) has been commonly used for uterine myoma with satisfactory effects, but the pain during and following the procedure with an occurrence rate in 100%. The aim of this study was to observe the effects of intermittent injection with super-low pressure on pain control during the UAE for uterine myoma. METHODS 67 subjects were divided into 2 groups with 47 in-group A and 20 in group B. A underwent UAE with the intermittent injection at super-low pressure, while B underwent routine UAE. Pain was assessed according to WHO analgesic ladder. Meanwhile, all were scored with the visual analogue scale (VAS). RESULTS The numbers of first, second and third step analgesic user in Group A were 21, 18 and 6, respectively, with 2 non-analgesic users, while in Group B were 4, 6 and 10, respectively without non-analgesic user (chi-square = 7.043, P = 0.008). VAS showed good pain control in 23 cases, satisfactory in 18 and poor in 6 in Group A, while in Group B, were 4, 8 and 8, respectively (chi-square = 7.329, P = 0.007). Mean follow-up was 16.5 months (range, 6-32 months). The abnormal menstruation was improved and the ultrasound examination 6 months later demonstrated a significant decrease in the diameter of myoma (from 6.65 ± 2.40 cm to 5.22 ± 1.86 cm, t = 3.186, P = 0.002). CONCLUSION The application of intermittent injection with super-low pressure during UAE can decrease and possibly eliminate post-operative pain. But the procedure time was increased.
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Affiliation(s)
- Jian-Bo Zhao
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Ze-Long Luo
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Chao Feng
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Qing-Le Zeng
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Xiao-Feng He
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Yan-Hao Li
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
| | - Yong Chen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University Guangzhou 510515, China
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Kim SY, Chang CH, Lee JS, Kim YJ, Kim MD, Han DW. Comparison of the Efficacy of Dexmedetomidine plus Fentanyl Patient-controlled Analgesia with Fentanyl Patient-controlled Analgesia for Pain Control in Uterine Artery Embolization for Symptomatic Fibroid Tumors or Adenomyosis: A Prospective, Randomized Study. J Vasc Interv Radiol 2013; 24:779-86. [DOI: 10.1016/j.jvir.2013.02.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE OF REVIEW Regional anesthesia is not only performed in the operating room. There are indications for the use of these techniques for pain relief in the emergency department and for anesthesia support of procedures outside the operating room. In this review, we will provide an overview of the indications for the regional techniques performed in the out-of-operating room environment. RECENT FINDINGS In the emergency department, patients may experience significant pain, and adequate analgesia is not always provided. Regional analgesia is effective and indicated for many trauma situations including hip fracture, reduction of shoulder dislocation, treatment of upper limb fractures and multiple rib fractures.Ultrasound guidance makes the performance of regional blocks more accessible and safer for use in the emergency department setting.For therapeutic procedures outside the operating room, regional anesthesia is possible for uterine artery embolization and for postoperative analgesia after implantation of cervical brachytherapy needles. SUMMARY Regional anesthesia is a valuable option for analgesia in trauma patients, enabling improved pain control in the emergency department and has benefits in the anesthetic management of therapeutic procedures outside the operating room. For many blocks, ultrasound guidance is useful.
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Vo NJ, Andrews RT. Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids. Semin Intervent Radiol 2011; 25:252-60. [PMID: 21326515 DOI: 10.1055/s-0028-1085923] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Leiomyomas (or fibroids) are exceedingly common lesions. The indications to initiate treatment are based on the symptoms that can arise from their presence. In general, medical therapy should be considered the first line of treatment. Currently, the treatment of fibroids is in evolution. Since uterine artery embolization (UAE) was first described by Ravina et al in 1995, it has been shown to be a safe, efficacious, and cost-effective alternative to traditional surgical options, with data from long-term studies now available. Appropriate patient evaluation and selection are vital; the ideal candidate is one who is premenopausal, has symptomatic fibroids resistant to medical therapy, no longer desires fertility, and wishes to maintain her uterus. Uterine artery embolization is primarily an angiographic procedure, but periprocedural clinical management is critical for patient satisfaction. This article discusses the various embolic materials that are commonly used and available for UAE; understanding the technical nuances is critical for long-term success.
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Affiliation(s)
- Nghia-Jack Vo
- Department of Radiology, Section of Vascular and Interventional Radiology University of Washington, Seattle, Washington
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Lipszyc M, Winters E, Engelman E, Baurain M, Barvais L. Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization. Br J Anaesth 2011; 106:724-31. [DOI: 10.1093/bja/aer041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization. Pharmaceuticals (Basel) 2010; 3:1729-1738. [PMID: 27713326 PMCID: PMC4033949 DOI: 10.3390/ph3061729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 04/30/2010] [Accepted: 05/24/2010] [Indexed: 11/26/2022] Open
Abstract
Uterine artery embolization (UAE) is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.
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Ruuskanen A, Sipola P, Hippeläinen M, Wüstefeld M, Manninen H. Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol 2009; 19:2977-85. [DOI: 10.1007/s00330-009-1481-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 11/29/2022]
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