Binkert Christoph A, Hirzel Florian C, Gutzeit Andreas, Zollikofer Christoph L, Hess Thomas
Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Department of Gynecology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Cardiovasc Intervent Radiol. 2015 Oct;38(5):1157-61. doi: 10.1007/s00270-015-1118-z. Epub 2015 May 15.
To evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.
In this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500-700 or 700-900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°-15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right-left distribution the needle was repositioned.
All SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s-9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.
The SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.
与硬膜外麻醉相比，评估改良的上腹下神经阻滞（SHNB）以减轻子宫动脉栓塞术（UAE）后的疼痛。
在这项回顾性研究中，比较了SHNB组和硬膜外麻醉组UAE术后所需阿片类药物的用量。连续81名女性（平均年龄：43.67岁）在SHNB组，27名连续女性（平均年龄：43.48岁）在同一机构较早接受治疗，在硬膜外麻醉组。UAE通过使用4F导管经单侧股动脉途径进行。500 - 700或700 - 900μm的三丙烯酸明胶微球用作栓塞剂。SHNB通过将一根21G的针从脐下的腹壁推进到第5椎体前部来进行。为了获得最佳引导，使用5° - 15°的头脚倾斜。在侧位片上确认椎体前方造影剂的正确分布。然后注入20ml局部麻醉药（0.75%罗哌卡因）。如果左右分布不对称，则重新定位针头。
所有SHNB均成功，无严重并发症。SHNB的平均时间为4分38秒（2分38秒 - 9分27秒）。针头平均重新定位0.87次。SHNB组的阿片类药物剂量为19.33±22.17mg，显著较低。SHNB后接受阿片类药物的平均时间为4小时41分钟。
SHNB是一种安全且耗时最少的减轻UAE后疼痛的方法，尤其是在最初4小时内。
