Superior Hypogastric Plexus Block for Pain Relief After Laparoscopic Hysterectomy: A Randomized Controlled Trial

Abstract

Study Objective To assess the efficacy of a superior hypogastric plexus block (SHPB) for pain relief following laparoscopic hysterectomy. Design Multi-center, single-blind, randomized controlled trial. Setting Brigham and Women's Hospital, Boston, MA, University of North Carolina Medical Center, Chapel Hill, NC, and George Washington University Hospital, Washington, D.C. Patients or Participants 100 patients undergoing laparoscopic hysterectomy for benign indications were recruited between January 2018 and February 2019. Interventions Patients were randomized to receive a SHPB (n = 50) or no block (n = 50) at the start of laparoscopic hysterectomy. The block contained 10 mL of 0.25% bupivacaine injected in the presacral space. Measurements and Main Results The proportion of patients with a mean VAS (visual analogue scale) pain score less than 4 within 2 hours postoperatively was defined a priori as the primary outcome and compared between the groups. An intention to treat analysis was performed. Patients in the SHPB group were 1.6-times more likely to have a mean VAS Conclusion SHPB reduces immediate postoperative pain after laparoscopic hysterectomy however this effect does not extend to two hours postoperatively. SHPB does not impact opioid consumption, long-term pain, or recovery unit time.