"Superior hypogastric nerve block is a valuable tool for pain relief in the setting of uterine fibroid embolisation. This procedure results in significant ischaemic pain, peaking at 6-8 hours and lasting approximately 24 hours, then followed by a lesser degree of post-embolisation pain which can last for several days. Acute pain is typically managed with IV opiate analgesia, necessitating overnight hospital admission. Use of superior hypogastric nerve block can allow for UFE on a day case basis."
"Chiba needle 20-21G, 15-20cm length20G needle will provide improved pushability if traversing the uterus"
"Superior hypogastric nerve block is associated with improved pain scores and reduced opiate analgesia requirement following UFE 1-3. A corticosteroid (for example 40mg triamcinolone) can be added to the injectate and has been shown to prolong the duration of pain relief 4."
"Superior hypogastric nerve block is a valuable tool for pain relief in the setting of uterine fibroid embolisation. This procedure results in significant ischaemic pain, peaking at 6-8 hours and lasting approximately 24 hours, then followed by a lesser degree of post-embolisation pain which can last for several days. Acute pain is typically managed with IV opiate analgesia, necessitating overnight hospital admission. Use of superior hypogastric nerve block can allow for UFE on a day case basis."
"tube in AP position with ~15o craniocaudal angulation, aiming for a true AP view of the L5 vertebral body"
"tube in AP position with ~15o craniocaudal angulation, aiming for a true AP view of the L5 vertebral body"
"fluoro in AP view to confirm bilateral spread of contrast/anaesthetic mixture, then inject another 10 mL anaesthetic; if satisfactory bilateral spread is not seen, reposition needle before injecting the second aliquot of anaesthetic"
"Superior hypogastric nerve block is associated with improved pain scores and reduced opiate analgesia requirement following UFE 1-3. A corticosteroid (for example 40mg triamcinolone) can be added to the injectate and has been shown to prolong the duration of pain relief 4."
"Chiba needle 20-21G, 15-20cm length20G needle will provide improved pushability if traversing the uterus"
Expected headings
"Preprocedural evaluation"
"Positioning/room set up"
"insert Chiba needle under fluoro guidance, until bone is felt; take care to avoid aortic bifurcation and intervertebral disc"
"remove stylet and inject 3 mL 1% lidocaine to anaesthetize periosteum; monitor for tachycardia which would suggest intravascular injection"
"fluoro in AP view to confirm bilateral spread of contrast/anaesthetic mixture, then inject another 10 mL anaesthetic; if satisfactory bilateral spread is not seen, reposition needle before injecting the second aliquot of anaesthetic"