Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study
To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge. Prospectively enrolled case–control study with retrospective analysis comprising 119 eligible patien...
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| Veröffentlicht in: | Clinical radiology 2024-05, Vol.79 (5), p.378-385 |
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| creator | Almazedi, B. Hunt, G.E.G. Bowker, A. |
| description | To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge.
Prospectively enrolled case–control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0–10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann–Whitney U-test. A p-value of |
| doi_str_mv | 10.1016/j.crad.2024.01.032 |
| format | Article |
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Prospectively enrolled case–control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0–10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann–Whitney U-test. A p-value of <0.05 defined significance.
Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred.
SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.
•Superior hypogastric nerve block (SHNB) is a safe and effective regional anaesthesia.•SHNB reduces pain and opioid requirements post uterine fibroid embolisation (UFE).•The addition of SHNB to an optimised analgesic regime may facilitate day-case UFE.•SHNB can potentially make UFE more cost-effective saving inpatient hospital beds.</description><identifier>ISSN: 0009-9260</identifier><identifier>EISSN: 1365-229X</identifier><identifier>DOI: 10.1016/j.crad.2024.01.032</identifier><identifier>PMID: 38383252</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><ispartof>Clinical radiology, 2024-05, Vol.79 (5), p.378-385</ispartof><rights>2024 The Royal College of Radiologists</rights><rights>Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c307t-a93d60b46285183e6ea699ea78c1d4aa3aa010bf864a335eded5487ce54c8c423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.crad.2024.01.032$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38383252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Almazedi, B.</creatorcontrib><creatorcontrib>Hunt, G.E.G.</creatorcontrib><creatorcontrib>Bowker, A.</creatorcontrib><title>Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study</title><title>Clinical radiology</title><addtitle>Clin Radiol</addtitle><description>To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge.
Prospectively enrolled case–control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0–10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann–Whitney U-test. A p-value of <0.05 defined significance.
Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred.
SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.
•Superior hypogastric nerve block (SHNB) is a safe and effective regional anaesthesia.•SHNB reduces pain and opioid requirements post uterine fibroid embolisation (UFE).•The addition of SHNB to an optimised analgesic regime may facilitate day-case UFE.•SHNB can potentially make UFE more cost-effective saving inpatient hospital beds.</description><issn>0009-9260</issn><issn>1365-229X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u1DAQhy0EotvCC3BAPnIgwf-STRAXVFGoVIkLSNysiT279ZLYqe1U2hvvwBvwaDwJjrZwRLZk2frmJ898hLzgrOaMt28OtYlga8GEqhmvmRSPyIbLtqmE6L89JhvGWF_1omVn5Dylw3pVQj0lZ7IrSzRiQ35dTzOYTMOOpmXG6EKkt8c57CHl6Az1GO-RDmMw36ldovN7uuSCeaQ7N8TgLMVpCKNLkF3wtOwZnKfJhIjpNQ2zW5mId4uLOKHP5RG8pQkmrCwcqXXJ3ELc41sK1EDC3z9-muBzDCNNebHHZ-TJDsaEzx_OC_L16sOXy0_VzeeP15fvbyoj2TZX0EvbskG1omt4J7FFaPseYdsZbhWABGCcDbuuVSBlgxZto7qtwUaZzighL8irU-4cw92CKeupfA3HETyGJWnRS6a2TdvzgooTamJIKeJOz9FNEI-aM7260Qe9utGrG824Lm5K0cuH_GWY0P4r-SujAO9OAJYu7x1GnYxDb9CW0ZmsbXD_y_8DoySk7A</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Almazedi, B.</creator><creator>Hunt, G.E.G.</creator><creator>Bowker, A.</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240501</creationdate><title>Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study</title><author>Almazedi, B. ; Hunt, G.E.G. ; Bowker, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-a93d60b46285183e6ea699ea78c1d4aa3aa010bf864a335eded5487ce54c8c423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Almazedi, B.</creatorcontrib><creatorcontrib>Hunt, G.E.G.</creatorcontrib><creatorcontrib>Bowker, A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Almazedi, B.</au><au>Hunt, G.E.G.</au><au>Bowker, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study</atitle><jtitle>Clinical radiology</jtitle><addtitle>Clin Radiol</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>79</volume><issue>5</issue><spage>378</spage><epage>385</epage><pages>378-385</pages><issn>0009-9260</issn><eissn>1365-229X</eissn><abstract>To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge.
Prospectively enrolled case–control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0–10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann–Whitney U-test. A p-value of <0.05 defined significance.
Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred.
SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.
•Superior hypogastric nerve block (SHNB) is a safe and effective regional anaesthesia.•SHNB reduces pain and opioid requirements post uterine fibroid embolisation (UFE).•The addition of SHNB to an optimised analgesic regime may facilitate day-case UFE.•SHNB can potentially make UFE more cost-effective saving inpatient hospital beds.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38383252</pmid><doi>10.1016/j.crad.2024.01.032</doi><tpages>8</tpages></addata></record> |
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| title | Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case–control study |
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