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• Intraoperative pain control for uterine artery embolization
• Intractable pain related to pelvic neoplasm, endometriosis, etc.
• Uncorrected coagulopathy
Positioning: supine or prone
Procedure often performed in setting of uterine fibroid embolization
• If femoral access, helpful to advance catheter to contralateral internal iliac artery to delineate aortic bifurcation
• If radial access, can use contrast injection to outline the bifurcation
Infraumbilical abdomen prepped
Needle: 15 cm, 20-25g Chiba or spinal needle
• Midline; lower half of L5 vertebral body
• Flatten the endplates of L5 using caudal tilt
• Advance needle to periosteum of L5 vertebral body
• Avoid disc
Collimate and use hemostats to avoid fluoroscopic exposure to hands
• Lateral view
• Inject contrast: retroperitoneal, nonvascular
• 3 way stopcock and microbore connection tubing helpful
• 15-25 mL of long acting anesthetic such as 0.5% Ropivacaine, 0.25% Bupivacaine, 0.5% Bupivacaine
• Maintain gentle forward pressure of needle
• Intravascular injection resulting in cardiac arrest or seizure
• Bowel or vascular injury
• Infection: discitis
• Major complications uncommon
 Yoon J, Valenti D, Muchantef K, et al. Superior Hypogastric Nerve Block as Post-Uterine Artery Embolization Analgesia: A Randomized and Double-Blind Clinical Trial. Radiology. 2018;289(1):248-254.
 Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 2013;30(4):354-63.
 Rasuli P, Jolly EE, Hammond I, et al. Superior hypogastric nerve block for pain control in outpatient uterine artery embolization. J Vasc Interv Radiol. 2004;15(12):1423-9.