Retrospective evaluation of effectiveness and safety of superior hypogastric plexus block for pain control compared to epidural anesthesia in uterine artery embolization for treatment of uterine fibroids

  • Purpose: To assess 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 79 women with symptomatic uterine fibroids were scheduled for percutaneous, transcatheter UAE. According to informed patients’ decision, women were assigned to two different approaches of pain management including either SHPB or EDA. Effectiveness outcome measure was reported using a numeric rating scale ranged from 1 to 10. 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. At UAE and up to 6 hours thereafter, women who received SHPB experienced stronger pain than those who received EDA (mean pain score at 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). Maximum pain 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.


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