Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids – A Retrospective Evaluation

Abstract

Purpose To assess the effectiveness of pain management with superior hypogastric plexus block (SHPB) compared to epidural anesthesia (EDA) in women requiring uterine artery embolization (UAE).

Materials and Methods In this retrospective, single-center, non-randomized trial we included 79 women with symptomatic uterine fibroids who were scheduled for percutaneous, transcatheter UAE. According to their informed decision, the women were assigned to two different approaches of pain management including either SHPB or EDA. The effectiveness outcome measure was patient reported pain using a numeric rating scale ranging from 1 to 10. The pain score was assessed at UAE, 2 hours thereafter, and at subsequent intervals of 6 hours up to 36 hours after intervention.

Results Treatment groups did not differ significantly regarding age, pain score for regular menstrual cramps, uterine fibroid size, location, and symptoms of uterine fibroids. During UAE and up to 6 hours thereafter, women who received SHPB experienced stronger pain than those who received EDA (mean pain score during UAE: 3.3 vs. 1.5, p < 0.001; at 2 hours: 4.4 vs. 2.8, p = 0.012; at 6 hours: 4.4 vs. 2.6, p = 0.021). The maximum pain level was 5.8 ± 2.9 with SHPB and 4.5 ± 2.9 with EDA (p = 0.086). Women with a history of severe menorrhagia tended to experience worse pain than those without (regression coefficient 2.5 [95 % confidence interval –0.3 to 5.3], p = 0.076).

Conclusion Among women who underwent UAE, pain management including SHPB resulted in stronger pain during and after the procedure than pain treatment including EDA.

Key Points:

• Pain control with superior hypogastric plexus block was worse than epidural anesthesia.

• Peak of pain was at 12 hours after uterine artery embolization.

• Maximum pain was independent from uterine fibroid size or location.

Citation Format

• Malouhi A, Aschenbach R, Erbe A et al. Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids – A Retrospective Evaluation. Fortschr Röntgenstr 2021; 193: 289 – 297

Zusammenfassung

Ziel Bestimmung der Wirksamkeit der Schmerzbehandlung durch Blockade des Plexus hypogastricus superior (superior hypogastric plexus block; SHPB) verglichen mit einer Epiduralanästhesie (EDA) bei Embolisation der Uterusarterien (uterine artery embolization; UAE).

Material und Methoden In diese retrospektive, monozentrische, nicht randomisierte Studie wurden 79 Frauen mit symptomatischem Uterusmyom eingeschlossen, für die eine perkutane UAE geplant war. Die Schmerzkontrolle erfolgte entweder mit Unterstützung des SHPB oder der EDA. Ergebnisparameter zur Wirksamkeit war die Schmerzstärke auf einer Skala von 1 bis 10. Abgefragt wurde die Schmerzstärke während sowie 2 Stunden nach UAE und jeweils im Abstand von 6 Stunden bis 36 Stunden nach der UAE.

Ergebnisse Die Behandlungsgruppen unterschieden sich nicht signifikant in Hinblick auf Alter, Schmerzstärke bei vorangegangenen Menstruationen, Größe und Lage der Myome sowie Symptome. Frauen, bei denen ein SHPB vorgenommen wurde, hatten stärkere Schmerzen als diejenigen, die eine EDA erhielten (mittlere Schmerzstärke während der UAE: 3,3 vs. 1,5, p < 0,001; nach 2 Stunden: 4,4 vs. 2,8, p = 0,012; nach 6 Stunden: 4,4 vs. 2,6, p = 0,021). Die maximale Schmerzstärke betrug 5,8 ± 2,9 mit SHPB und 4,5 ± 2,9 mit EDA (p = 0,086). Patientinnen, mit Menorrhagien in der Vorgeschichte neigten zu stärkeren Schmerzen als andere (Regressionskoeffizient 2,5 [95 %-Konfidenzintervall –0,3 bis 5,3], p = 0,076).

Schlussfolgerung Frauen, bei denen eine Embolisation der Uterusarterien durchgeführt wurde, empfanden während und nach dem Eingriff unter einem SHPB stärkere Schmerzen als mit EDA.

Kernaussagen:

• Die Schmerzkontrolle durch Blockade des Plexus hypogastricus superior war der Epiduralanästhesie unterlegen.

• Die Schmerzen erreichten 12 Stunden nach Embolisation ihren Höhepunkt.

• Die maximale Schmerzstärke war unabhängig von der Größe und Lage des Myoms.

Key words

fibroids - interventional pain management - microspheres - nerve block - pelvic pain - superior hypogastric plexus

Publication History

Received: 11 May 2020

Accepted: 20 July 2020

Article published online:
03 September 2020

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