Pereira Keith, Morel-Ovalle Louis Maurice, Taghipour Mehdi, Sherwani Afsheen, Parikh Roshni, Kao Jerome, Vaheesan Kirubahara
Saint Louis University, 3635 Vista avenue, St. Louis, MO, 63110, USA.
Einstein Medical Center Montgomery, East Norriton, PA, USA.
CVIR Endovasc. 2020 Sep 27;3(1):50. doi: 10.1186/s42155-020-00141-2.
Superior Hypogastric nerve Block (SHNB) has been shown to be an effective pain management technique after Uterine Fibroid Embolization (UFE), reducing the need for opiates and allowing same-day discharge after UFE. In this technical note we discuss relevant anatomy and technical details in performing SHNB.
The Superior hypogastric plexus (SHP) is the part of the abdominopelvic sympathetic nervous system that provides a targeted intervention to sympathetic-mediated pain pathways of pelvic organs and a target for an anterior approach Superior Hypogastric nerve Block after embolization. Vascular structures are in close relation to the intended site of target of the SHP at the L5 vertebral body include aortic bifurcation and IVC confluence, hence a detailed knowledge of this is essential. A step by step technical approach to SHNB includes patient positioning for the block, image guidance and needle positioning, choice and technique of anesthetic injection. Traversing a large fibroid uterus, inadvertent vascular opacification and Local anesthetic systemic toxicity present challenges to performing the block and are addressed.
Superior Hypogastric nerve Block (SHNB) can be a useful tool in the Interventional armamentarium to make UFE a better experience for patients with fibroids, allowing for better pain control as well as facilitating same day discharge. Performing SHNB appear to be can be performed with technical ease for an interventional radiologist.
上腹下神经阻滞（SHNB）已被证明是子宫肌瘤栓塞术（UFE）后一种有效的疼痛管理技术，可减少阿片类药物的使用，并使UFE术后患者能够当日出院。在本技术说明中，我们讨论了进行SHNB的相关解剖结构和技术细节。
上腹下丛（SHP）是腹盆腔交感神经系统的一部分，为盆腔器官的交感神经介导的疼痛通路提供靶向干预，也是栓塞术后前路上腹下神经阻滞的靶点。在L5椎体水平，血管结构与SHP的预期靶点位置关系密切，包括主动脉分叉和下腔静脉汇合处，因此对此有详细了解至关重要。SHNB的逐步技术方法包括阻滞时患者的体位、影像引导和针的定位、麻醉剂注射的选择和技术。在穿过巨大子宫肌瘤子宫时，意外的血管造影剂显影和局部麻醉药全身毒性给实施阻滞带来了挑战，本文对此进行了探讨。
上腹下神经阻滞（SHNB）可以成为介入治疗手段中的一种有用工具，使UFE对子宫肌瘤患者来说体验更佳，实现更好的疼痛控制并便于当日出院。对于介入放射科医生而言，实施SHNB在技术上似乎易于操作。
