Superior hypogastric nerve block (SHNB) for pain control after uterine fibroid embolization (UFE): technique and troubleshooting.

BACKGROUND: Superior Hypogastric nerve Block (SHNB) has been shown to be an effective pain management technique after Uterine Fibroid Embolization (UFE), reducing the need for opiates and allowing same-day discharge after UFE. In this technical note we discuss relevant anatomy and technical details in performing SHNB. MAIN BODY: The Superior hypogastric plexus (SHP) is the part of the abdominopelvic sympathetic nervous system that provides a targeted intervention to sympathetic-mediated pain pathways of pelvic organs and a target for an anterior approach Superior Hypogastric nerve Block after embolization. Vascular structures are in close relation to the intended site of target of the SHP at the L5 vertebral body include aortic bifurcation and IVC confluence, hence a detailed knowledge of this is essential. A step by step technical approach to SHNB includes patient positioning for the block, image guidance and needle positioning, choice and technique of anesthetic injection. Traversing a large fibroid uterus, inadvertent vascular opacification and Local anesthetic systemic toxicity present challenges to performing the block and are addressed. CONCLUSION: Superior Hypogastric nerve Block (SHNB) can be a useful tool in the Interventional armamentarium to make UFE a better experience for patients with fibroids, allowing for better pain control as well as facilitating same day discharge. Performing SHNB appear to be can be performed with technical ease for an interventional radiologist.

Subclinical orthostatic pulse pressure confirms mothers' ratings of ADHD in preschoolers.

Subclinical levels of orthostatic hypotension (OH) have been linked to a variety of emotional and behavioral outcomes across the life span. These connections are not surprising, given the multitude of correlated conditions, including autonomic control, cardiovascular functioning, baroreceptor activity, and dopamine and serotonin. The current study assessed blood pressure regulation in healthy preschool children ages 3-5 (n = 61). The Conner's Parent Rating Scale Revised was used to assess indexes of attention deficit hyperactivity disorder (ADHD). With the difference between standing and supine pulse pressure as the index of orthostatic blood pressure regulation, the results indicated that efficient pulse pressure regulation was significantly correlated with lower ADHD scores. Poorer orthostatic pulse pressure regulation in response to an orthostatic challenge may be a risk for symptoms of ADHD.