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Updated: Apr 12, 2026

Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison
Christoph A Binkert1, Florian C Hirzel2,3, Andreas Gutzeit4,5
1Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. christoph.binkert@ksw.ch.
Purpose:
To evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.
Materials And Methods:
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.
Results:
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.
Conclusion:
The SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.
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