Uterine fibroid characteristics and intraoperative analgesic requirements during high intensity focused ultrasound therapy at a central hospital

Abstract

Background Uterine fibroids affect 25% ─ 44 % of women of reproductive age. High intensity focused ultrasound (HIFU) is a non-invasive treatment for fibroids, that is becoming increasingly popular as it has many advantages over surgical procedures. The clinical impression at Chris Hani Baragwanath Academic Hospital (CHBAH) is that HIFU therapy for fibroids is very painful. Methods A retrospective, contextual and descriptive study was done reviewing all HIFU records (n=236) at CHBAH from 13 October 2015 to 30 September 2017. Results Of the anaesthetic charts, 223 (94.5%) were available for analysis. Having multiple fibroids increased (p=0.002) the likelihood of requiring higher dosages of short-acting opioids. An increase in treatment time had a high likelihood of resulting in an increase in both short- (p=0.004) and long-acting (p=0.001) opioid requirements and an increase in energy used had a high likelihood of increasing long-acting opioid (p=0.002) requirements. Body mass index (BMI) influenced intraoperative analgesic requirements. Patients who had a normal BMI were likely to require less intraoperative analgesic drugs than those who were overweight and obese. Conclusions Most of the patients presenting at CHBAH for HIFU therapy have multiple fibroids and judging by the of intraoperative analgesia administered, HIFU treatment appears to be very painful, which is not in keeping with most other studies.