Purpose To evaluate the effectiveness of superior hypogastric nerve block (SHNB) in reducing narcotic use after uterine artery embolization (UAE). Materials and Methods This study was a prospective, randomized, double-blind, parallel clinical trial in patients referred to a tertiary care university teaching hospital for UAE. Forty-four participants were enrolled (mean age, 46 years; range, 32-56 years). No consenting patient was excluded. All participants were randomized 1:1 to undergo either a sham procedure or SHNB. There were 22 participants in each group. One participant was lost to follow-up regarding home survey results. Use of narcotics and antiemetics was recorded in-hospital. Pain scores were recorded at home for 10 days with use of a visual analog scale (range, 1-10). Statistical analysis was performed by using the t test and χ test, with P < .05 considered indicative of a statistically significant difference. The full study protocol can be found at www.clinicaltrials.gov (NCT02270255). Results Participant demographic characteristics, fibroid volume, symptoms, and perceived sensitivity to pain were similar in both groups. Immediately after embolization, the pain score was lower in the SHNB group than in the sham group (mean, 1.0 ± 2.1 vs 2.6 ± 2.0, respectively; P = .01). The total need for fentanyl in the postanesthesia care unit was lower in the SHNB group than in the sham group (mean, 56 μg ± 67 vs 124 μg ± 91, respectively; P = .009). The morphine-equivalent dose needed was lower in the SHNB group than in the sham group (mean, 5.1 mg ± 5.8 vs 11.0 mg ± 9.0, respectively; P = .014). Of the 22 participants in the SHNB group, five (23%) needed antiemetics versus 12 of 22 participants (55%) in the sham group (P = .03). No difference in hospital admissions was observed between the two groups, and no major complications occurred from the SHNB. Conclusion Use of superior hypogastric nerve block reduces the amount of pain-related narcotics and antiemetics after uterine artery embolization. © RSNA, 2018.

269ticle by Henzler et al that the authors mention in their letter compared radiation doses of dual-energy CT and single-energy CT in more than 250 peer-reviewed studies, with Henzler et al concluding that "there is strong evidence that [dual-energy CT] imaging with [dual-source CT] is not associated with increased radiation dose levels" (2). This has been reaffirmed in the meantime by multiple studies that demonstrated equal or even lower radiation dose of a third-generation dual-source CT system (which was used in our study) and other dual-energy CT systems in comparison to single-energy CT (3,4). Thus, dual-energy CT is considered a viable and effective alternative to single-energy CT, providing reliable image quality without increased radiation dose and, often, additional diagnostic information.Furthermore, we fully agree with their opinion regarding the value of MRI as a comprehensive modality to visualize various diseases of the spine and, consequently, potential causes for lower back pain. The goal of our study was therefore not to develop a dual-energy CT technique to replace MRI, but instead to maximize the information obtained from CT that is frequently performed in clinical routine but in which lumbar disk herniation is often not reported due to technical limitations. While we are confident that dual-energy CT may also be able to depict other abnormalities that can be commonly observed with MRI in patients with lower back pain, such as bone marrow edema (5), we decided to focus our study on a direct comparison of diagnostic performance between these modalities regarding depiction of lumbar disk herniation and spinal nerve root impingement. Other potential causes of lower back pain were therefore not included but may be an interesting subject for future studies. We believe that our findings add to the growing set of dual-energy CT techniques that provide additional information in routine imaging to improve diagnosis and, ultimately, treatment.

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