The role of intraoperative superior hypogastric plexus blocks in pain management for total abdominal hysterectomy: a comparative study

Yıl 2023, Cilt: 9 Sayı: 5 - September 2023, 1201 - 1206, 04.09.2023

Elif Gundogdu Tuğba Gül Yılmaz

https://doi.org/10.18621/eurj.1340891

Öz

Objectives: This study aimed to investigate the efficacy of intraoperative Superior Hypogastric Plexus Blocks (SHPBs) in managing postoperative pain following total abdominal hysterectomy, comparing pain scores and analgesic requirements between patients who received SHPBs and those who did not.

Methods: A prospective, randomized, controlled trial was conducted on 70 female patients undergoing elective total abdominal hysterectomy. Patients were randomly assigned to either the SHPB group or the non-SHPB group. In the SHPB group, intraoperative SHPBs were administered after uterine removal. Postoperative pain scores were assessed using the Visual Analogue Scale (VAS) at various time points. Analgesic consumption and adverse effects were also recorded.

Results: Patients in the SHPB group consistently exhibited lower pain scores compared to the non-SHPB group at various postoperative time intervals (p < 0.05). Initial analgesic requirements were significantly higher in the non-SHPB group, as was total analgesic consumption during the hospital stay (p < 0.05). No significant complications related to SHPB administration were observed.

Conclusions: Intraoperative Superior Hypogastric Plexus Blocks demonstrated a potential benefit in reducing postoperative pain scores and analgesic consumption in patients undergoing total abdominal hysterectomy. These findings highlight the potential of SHPBs as an effective approach to enhance pain management in this surgical population, warranting further investigation and refinement of administration protocols.

Anahtar Kelimeler

Pain management, gynecological surgical procedures, analgesia, laparotomy, hysterectomy, elective surgical procedures

Kaynakça

• 1. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17:131-57.
• 2. Sindt JE, Brogan SE. Interventional treatments of cancer pain. Review. Anesthesiol Clin 2016;34:317-39.
• 3. Miguel R. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control 2000;7:149-56.
• 4. Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med 2005;206:277-81.
• 5. Bosscher H. Blockade of the superior hypogastric plexus block for visceral pelvic pain. Pain Practice 2001;1:162-70.
• 6. Aytuluk HG, Kale A, Astepe BS, Basol G, Balci C, Colak T. Superior hypogastric plexus blocks for postoperative pain management in abdominal hysterectomies. Clin J Pain 2020;36:41-6.
• 7. Astepe BS, Aytuluk HG, Yavuz A, Turkay U, Terzi H, Kale A. Intraoperative superior hypogastric plexus block during cesarean section: a new technique for pain relief. J Matern Fetal Neonatal Med 2020;33:2657-63.
• 8. Aytuluk HG, Kale A, Basol G. Laparoscopic superior hypogastric blocks for postoperative pain management in hysterectomies: a new technique for superior hypogastric blocks. J Minim Invasive Gynecol 2019;26:740-7.
• 9. Rapp H, Ledin Eriksson S, Smith P. Superior hypogastric plexus block as a new method of pain relief after abdominal hysterectomy: double-blind, randomised clinical trial of efficacy. BJOG 2017;124:270-6.
• 10. Christo PJ, Mazloomdoost D. Interventional pain treatments for cancer pain. Ann N Y Acad Sci 2008;1138:299-328.
• 11. Janig W, Basbaum AI, Bushnell MC. Autonomic nervous system and pain. Science of Pain. Oxford: Academic Press. 2009: pp. 193-235.
• 12. McDonnell JG, Finnerty O, Laffey JG. Stellate ganglion blockade for analgesia following upper limb surgery. Anaesthesia 2011;66:611-4.
• 13. Dooley J, Beadles C, Ho KY, Sair F, Gray-Leithe L, Huh B. Computed tomography-guided bilateral transdiscal superior hypogastric plexus neurolysis. Pain Med 2008;9:345-7.
• 14. Api M, Boza A, Ceyhan M, Kaygusuz E, Yavuz H, Api O. The efficacy of laparoscopic presacral neurectomy in dysmenorrhea: is it related to the amount of excised neural tissue? Turk J Obstet Gynecol 2017;14:238-42.