Use of Spinal Anesthesia for Postoperative Analgesia After U
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Uterine fibroids are benign neoplasms of the myometrium. Patient presents with symptoms of menorrhagia, pain and the sensation of pressure. Uterine artery embolization (UAE) has been shown to be an alternative treatment to hysterectomy, however, postprocedural pain remains a barrier to more widespread use.

Initial postprocedural pain usually peaks 6-8 hours after UAE and lasts up to 24 hours. It is usually severe and is caused primarily by tissue ischemia. Secondary, more manageable discomfort continues for 1-2 days, gradually decreasing over 6-8 days, and is a manifestation of post-embolization syndrome, in which cell death results in a release of inflammatory mediators that initiates nociception.

The use of spinal analgesia (SA) is a very attractive technique to reduce and modify pain after UAE. Spinal analgesia causes nociceptors to be resistant to noxious stimuli and silent nociceptors become dormant for the duration of the block. As a result, transmission, modulation and perception do not occur for the length of the block, and the brain does not interpret tissue injury as pain. After SA wears off, nociceptors become sensitive to inflammatory mediators with less or mild nociceptive response to ascending pathways.

Use of a spinal block for anesthetic management of UAE reduces the need for pain-related narcotics and antiemetics without exposing the patient to increased risks, and should help alleviate patient anxiety concerning pain from this procedure. It is a delicate, reliable and well-accepted procedure by patients. With encouraging results in both postoperative analgesia and patient satisfaction, without significant adverse events.