Uterine artery embolization under epidural neuraxial blockade - an effective anaesthetic/analgesic alternative: about two case reports
Mrs. Maria Raquel Caetano
Canada 
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6 slide(s) – English – 2011-09-08
Uterine artery embolization under epidural neuraxial blockade – an effective anaesthetic/analgesic alternative: about two case reports
Caetano, R.; Oliveira, C.; Teixeira, R.; Lima, F.
Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Portugal
Abstract
Although mostly benign, uterine fibroids can cause heavy and prolonged bleeding, pain, pressure symptoms and subfertility. As long term medical therapies have not been shown to be effective, surgery has been the traditional treatment. Uterine artery embolization (UAE) has been reported to be a safe and effective alternative to treat symptoms in women who do not desire future fertility. Epidural neuraxial blockade anesthesia is an alternative technique to total intravenous anesthesia/sedation procedure and can replace PCIA (Patient Controlled Intravenous Analgesia) for the control of severe pain during the 24 hours after UAE.
We report two cases: 35 year old female, ASAII, with a 7.5 cm diameter uterine fibroid which caused severe pelvic pressure; 41 year old female, ASAI, with a large fibromiomatous uterus and significant associated menorragic history. Both submitted to UAE under epidural anesthesia. The procedure, begun with standard monitoring and administration of prophylactic antibiotherapy and mydazolam intravenous bolus, followed by epidural space catheterization under local anaesthesia. A bolus of morphine 3 mg and ropivacaine 0,75% were administered through the epidural catheter , to achieve a satisfactory level anaesthetic blockade. Alfentanil, in a dose of 0.05 mg intravenous bolus was administered at the precise two moments of arteries embolization.
Both patients stayed cooperative and confortable, breathing spontaneously, presenting haemodinamic(HD)stability with oxygen support and crystalloid fluid infusion during the procedures that underwent without complications.
For the first 24 hours after de UAE, patients were admitted to the PACU (Post Anesthesia Care Unity). Post op analgesia was assured with variable dose epidural perfusion of local anaesthetic (LA) ( ropivacaine 0,2% )and paracetamol 1000 mg – 6/6h intravenous bolus.
In the first case no NSAID was given. The patient remained calm, with HD stability and low pain levels(EVA 2 to 4).
In the latter case, in which NSAID was used, difficult pain control was described, and rescue opioid IV perfusion and bolus were necessary to keep the patient confortable, despite rescue LA epidural bolus was given. It was then decided to place and use a new epidural catheter, with revealed itself to be effective and pain control was achieved.
Therefore, the authors concluded that the first catheter was at somepoint dislogged and misplaced. No side effects were noticed in both cases. Released 24 hours after admission in PACU to Gynecology Department and discharged home three days after the procedure.
Despite scientific literature is not consensual about the best anaesthetic approach, epidural neuraxial blockade anesthesia has shown to be a safe and effective alternative technique to total intravenous anesthesia/sedation, and a valuable part of a multimodal scheme to control severe pain levels.
Keywords
Uterine artery embolization (UAE); Epidural neuraxial blockade anesthesia; Control severe pain levels during the 24 hours after UAE
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