Comparison of effectiveness of epidural analgesia and monitored anesthesia care for high-intensity focused ultrasound treatment of adenomyosis

Abstract

Background: High-intensity focused ultrasound (HIFU) is a noninvasive thermodestructive procedure targeting internal organs with concentrated sonification energy that may cause pain. We aimed to compare the effectiveness of epidural analgesia (EA) and monitored anesthesia care (MAC) in HIFU treatment of uterine adenomyosis. Materials and Methods: Sixty-eight patients were included in this case-control study. Thirty-seven patients underwent MAC; 31 patients underwent fluoroscope-guided epidural analgesia. The primary outcome was a frequency of patients reporting severe or very severe intraoperative pain. Secondary outcomes were differences in dosages of analgesics, ablation ratio, and other clinical factors. Results: The EA group reported a significantly lower frequency of severe or very severe intraoperative pain than did the MAC group (41.9% vs. 75.7%; p ¼ .006). Consumption of remifentanil during treatment was significantly lower in the EA group (173 ± 189 mg vs. 426 ± 380 mg; p ¼ .001), as was the use of fentanyl in the recovery room (52 ± 38 mg vs. 75 ± 44 mg; p ¼ .030). Multivariable analysis revealed EA to be the largest contributing factor to increased nonperfused volume ratio (B ¼ 0.41; 95% confidence interval ¼ 0.29 to 0.53; p < .001). The frequency of thermal injury after HIFU was significantly lower in the EA group (22.6% vs. 54.1%; p ¼ .008). Conclusions: EA during HIFU treatment of uterine adenomyosis improved quality of pain control and ablation ratio over MAC without increasing risk of treatment-related complications. EA also reduced consumption of opioid analgesics during and after HIFU treatment. ARTICLE HISTORY

Optimized treatment parameter by computer simulation for high-intensity focused ultrasound treatment of uterine adenomyosis: Short-term and long-term results

“…The optimized parameters, along with the acoustic power associated with the treatment parameter group, were independently linked to variable qualitative or quantitative outcomes. While a previous study reported that the mode of anesthesia (MAC vs. EA) was associated with NPVR in the treatment of uterine adenomyosis, their assessment was limited to immediate post-HIFU MRI [ 31 ]. In contrast, our study extended the follow-up period to 3 months or 3 years and employed appropriate statistical methods (specifically, generalized linear mixed model) to analyze the impact of various variables.…”

“…In terms of the mode of anesthesia, all of the participants in Group A received monitored anesthesia care (MAC); in Group B, the first 16 participants received MAC, and the later 30 participants received epidural anesthesia (EA). A previous study from our institution summarized the details of MAC and EA and evaluated the association between the mode of anesthesia and the HIFU treatment outcome [ 31 ]. The participants were blinded to this allocation based on treatment parameters.…”

Effect of Paracervical Block Before Ultrasound Guided High Intensity Focused Ultrasound Treatment in Uterine Fibroids and Adenomyosise

“…Lee et al [9] reported a comparison of the effectiveness of epidural analgesia and monitored anesthesia for pain relief during high-intensity-focused ultrasound treatment of adenomyosis.…”