REGULAR CONTENT
Final ID
674
Type
Educational Exhibit-Poster Only
Authors
C Yarosh1, C Hoffman1, E Boyd1, W Koh2, G Kim1, S Chaabane1, P Kay1, J Jahr1
Institutions
1UCLA, Los Angeles, CA, 2Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Yeongnam
Purpose
1. Review radiological anatomy, aortic and iliocaval bifurcations, in relation to the L4-S1 vertebral bodies2. Review important properties of anesthetics used: ropivacaine vs. bupivacaine 3. Review rescue options, such as intravenous lipid emulsion, in the event of an unintentional intravascular injection
Materials & Methods
For the last 20 years, uterine fibroid embolization (UFE) has been a successful treatment option for women with symptomatic fibroids and adenomyosis. Adequately treating the patient's pain and nausea is a continuing challenge. Recently, superior hypogastric nerve block (SHNB) has been revisited as a successful adjunct technique for decreasing pain post-embolization. This form of regional anesthesia has been found to be effective.(1) Previous studies on SHNB are based on a femoral approach and fluoroscopic evaluation of the aortic bifurcation. As we transition to radial access, this guidance is not available.
Results
MRI images are readily available in UFE patients, as this study is usually performed prior to UFE. We will examine the location of vascular structures relative to the mid-to-inferior L5 vertebral body, the typical target for SHNB, so that these vessels can be avoided.(2) Selection of the optimum anesthetic choice (ropivacaine versus bupivacaine) and rescue options, such as administration of intravenous lipid emulsion in the case of unintentional intravenous injection, will be discussed.(3)
Conclusions
With understanding of the varying anatomic locations of the aortic and iliocaval bifurcations and pre-procedure evaluation of the patient's MRI images, intravenous anesthetic injection can be avoided during SHNB administration. Additionally, having intravenous lipid emulsion and standard resuscitation methods on hand in case of unintentional intravenous anesthetic injection makes SHNB a low-risk pain control method that can improve the postoperative experience of UFE patients.
Final ID
674
Type
Educational Exhibit-Poster Only
Authors
C Yarosh1, C Hoffman1, E Boyd1, W Koh2, G Kim1, S Chaabane1, P Kay1, J Jahr1
Institutions
1UCLA, Los Angeles, CA, 2Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Yeongnam
Purpose
1. Review radiological anatomy, aortic and iliocaval bifurcations, in relation to the L4-S1 vertebral bodies2. Review important properties of anesthetics used: ropivacaine vs. bupivacaine 3. Review rescue options, such as intravenous lipid emulsion, in the event of an unintentional intravascular injection
Materials & Methods
For the last 20 years, uterine fibroid embolization (UFE) has been a successful treatment option for women with symptomatic fibroids and adenomyosis. Adequately treating the patient's pain and nausea is a continuing challenge. Recently, superior hypogastric nerve block (SHNB) has been revisited as a successful adjunct technique for decreasing pain post-embolization. This form of regional anesthesia has been found to be effective.(1) Previous studies on SHNB are based on a femoral approach and fluoroscopic evaluation of the aortic bifurcation. As we transition to radial access, this guidance is not available.
Results
MRI images are readily available in UFE patients, as this study is usually performed prior to UFE. We will examine the location of vascular structures relative to the mid-to-inferior L5 vertebral body, the typical target for SHNB, so that these vessels can be avoided.(2) Selection of the optimum anesthetic choice (ropivacaine versus bupivacaine) and rescue options, such as administration of intravenous lipid emulsion in the case of unintentional intravenous injection, will be discussed.(3)
Conclusions
With understanding of the varying anatomic locations of the aortic and iliocaval bifurcations and pre-procedure evaluation of the patient's MRI images, intravenous anesthetic injection can be avoided during SHNB administration. Additionally, having intravenous lipid emulsion and standard resuscitation methods on hand in case of unintentional intravenous anesthetic injection makes SHNB a low-risk pain control method that can improve the postoperative experience of UFE patients.