Anaesthetic Management During High-Intensity Focused Ultrasound for Uterine Fibroids and Adenomyosis: A Narrative Review.

Samantha Govender, Harshal J. Mistry
In: Student's Journal of Health Research Africa · 2026 · vol. 7(3) , pp. 7 · doi:10.51168/ca520z37 · W7221912447
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This narrative review compares anaesthetic techniques for high-intensity focused ultrasound in uterine fibroids and adenomyosis, finding no superior method due to heterogeneous evidence regarding efficacy, safety, and patient outcomes.

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This narrative review evaluates anaesthetic and analgesic techniques used during high-intensity focused ultrasound treatment for uterine fibroids and adenomyosis. The authors analyzed existing literature to compare the efficacy, safety, and clinical outcomes of systemic analgesia, conscious sedation, regional anaesthesia, and general anaesthesia. Key findings indicate that systemic analgesia alone is often insufficient, while epidural anaesthesia provides effective pain relief despite potential complications, and no single technique has been proven superior due to heterogeneous evidence. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Abstract High-intensity focused ultrasound (HIFU) is a non-invasive treatment option for uterine fibroids and adenomyosis. The procedure requires prolonged patient immobility while maintaining adequate analgesia and, where possible, communication with the operator. The choice of anaesthetic technique is therefore important, but evidence regarding optimal anaesthetic management remains limited. This narrative review aimed to identify and compare anaesthetic and analgesic techniques used during HIFU treatment of uterine fibroids and adenomyosis, with consideration of their efficacy, safety and reported clinical outcomes. An electronic literature search was conducted using PubMed, MEDLINE, Google Scholar and the Cochrane Library. Studies were included if they reported an anaesthetic or analgesic technique used during HIFU for uterine fibroids or adenomyosis and described relevant outcomes or adverse effects. The available evidence included systemic analgesia, conscious sedation, regional anaesthesia and general anaesthesia. Systemic analgesia alone appeared insufficient to provide consistent pain relief. Opioid and sedative combinations allowed communication but ongoing pain was reported in several studies. Dexmedetomidine-remifentanil was associated with less respiratory depression, improved sedation and recovery compared with midazolam-remifentanil in one randomised controlled trial. Regional techniques, particularly epidural anaesthesia, provided effective analgesia and reduced opioid requirements, although rescue analgesia and neuraxial complications were reported. General anaesthesia was less frequently described and may limit communication during treatment. Overall, the evidence was heterogeneous, with inconsistent reporting of pain, sedation, patient satisfaction and adverse outcomes. Current evidence does not establish the superiority of any one anaesthetic technique. Future prospective studies should directly compare techniques using standardised measures of pain, sedation, patient comfort, respiratory and cardiovascular safety, rescue analgesia, and treatment-related outcomes. Such evidence may help guide anaesthetic practice and improve the safety and patient experience of HIFU treatment.
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Abstract

High-intensity focused ultrasound (HIFU) is a non-invasive treatment option for uterine fibroids and adenomyosis. The procedure requires prolonged patient immobility while maintaining adequate analgesia and, where possible, communication with the operator. The choice of anaesthetic technique is therefore important, but evidence regarding optimal anaesthetic management remains limited. This narrative review aimed to identify and compare anaesthetic and analgesic techniques used during HIFU treatment of uterine fibroids and adenomyosis, with consideration of their efficacy, safety and reported clinical outcomes. An electronic literature search was conducted using PubMed, MEDLINE, Google Scholar and the Cochrane Library. Studies were included if they reported an anaesthetic or analgesic technique used during HIFU for uterine fibroids or adenomyosis and described relevant outcomes or adverse effects. The available evidence included systemic analgesia, conscious sedation, regional anaesthesia and general anaesthesia. Systemic analgesia alone appeared insufficient to provide consistent pain relief. Opioid and sedative combinations allowed communication but ongoing pain was reported in several studies. Dexmedetomidine-remifentanil was associated with less respiratory depression, improved sedation and recovery compared with midazolam-remifentanil in one randomised controlled trial. Regional techniques, particularly epidural anaesthesia, provided effective analgesia and reduced opioid requirements, although rescue analgesia and neuraxial complications were reported. General anaesthesia was less frequently described and may limit communication during treatment. Overall, the evidence was heterogeneous, with inconsistent reporting of pain, sedation, patient satisfaction and adverse outcomes. Current evidence does not establish the superiority of any one anaesthetic technique. Future prospective studies should directly compare techniques using standardised measures of pain, sedation, patient comfort, respiratory and cardiovascular safety, rescue analgesia, and treatment-related outcomes. Such evidence may help guide anaesthetic practice and improve the safety and patient experience of HIFU treatment.

References

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