Work

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

Year: 2026

Type: review

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.

Source: Student s Journal of Health Research Africa

DOI: 10.51168/ca520z37

Authors: Samantha Govender, Harshal J Mistry

Institutions: Chris Hani Baragwanath Hospital, University of the Witwatersrand

Language: English

Topic: Anesthesia and Pain Management

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $40