By Ed Susman
Almost half the women treated with uterine artery embolization to reduce the size of fibroids required no perioperative pain medication when interventional radiologists employed radial artery access and superior hypogastric nerve block, according to a study presented here at the 2019 Annual International Symposium on Endovascular Therapy (ISET).
Of the 102 women treated with the procedure, 95% were discharged on the same day of the procedure, with a median time to hospital discharge of 2 hours and 48 minutes. Seven patients were admitted after the procedure due to pain or nausea and vomiting, and 2 were planned.
The average maximum recorded perioperative pain was 3.5 measured on a 0 to 10 visual analogue scale.
Suehyb Alkhatib, MD, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and colleagues suggested that the use of radial access can reduce healthcare costs, improve patients comfort, reduce time to discharge, and has technical success comparable with femoral artery access.
In the current retrospective study, technical success was achieved in 96 of the 102 women, but 2 women were converted to femoral artery access due to vasospasm, which appears to be more prevalent in younger women. In 1 case in the series, intervention was required to release a guiding catheter due to spasm.
“Anecdotally, we believe that superior hypogastric nerve block to be distinctly more effective than use of narcotics to control post-operative pain,” said Dr. Alkhatib.
The women in the study were give fentanyl during the operation.
“We believe these data represent an accurate picture of the range of patient experience in our department and provides a strong case for offering both radial access and the superior hypogastric nerve block for outpatient uterine artery embolization,” said Dr. Alkhatib.
He noted that there can be complications using the nerve block, and 1 woman developed a pre-sacral haemorrhage followed by spinal osteomyelitis and required 6 weeks of antibiotics before the infection resolved. He also noted that lidocaine and other drugs used in performing the nerve block have their own risks, but none were observed in the study patients.
Within 1 week of the procedure, 10 women re-presented, 3 were seen as outpatients, and 7 were admitted for observation. Two women required dilation and curettage due to incomplete fibroid expulsion, 1 patient re-bled from the radial artery access site, but that was resolved in the emergency department.
[Presentation title: Transradial Uterine Artery Embolization With the Superior Hypogastric Nerve Block: Rapid Discharge With Minimal Pain. Abstract 138]