Superior Hypogastric Plexus Block Research Articles

Safety and efficacy of ultrasound-guided superior hypogastric plexus block combined with conscious sedation in ambulatory patients undergoing percutaneous microwave ablation of uterine myomas: Study protocol for a single-center, double-blinded, randomized controlled trial

BackgroundPain is a major challenge in performing ultrasound-guided percutaneous microwave ablation (PMWA) of uterine myomas. Inadequate analgesia by local anesthetics hinders the possibility of conducting PMWA of uterine myomas in the Ambulatory Surgery Center (ASC) of the Department of Ultrasound. ObjectiveThe superior hypogastric plexus (SHP) forms a suitable target for pain relief through the blockade, as it contains nociceptive afferent fibers from pelvic organs such as the uterus, rectum, and bladder. Superior hypogastric plexus block (SHPB) has demonstrated promise as an alternative treatment option for alleviating pelvic pain, reducing opioid consumption, and improving quality of life. This study aims to evaluate the efficacy of ultrasound-guided SHPB combined with conscious sedation as an alternative anesthesia option for ambulatory patients receiving ultrasound-guided PMWA of uterine myomas. Methods and analysisThis randomized controlled trial (RCT) will be carried out at the Department of Ultrasound, The First Affiliated Hospital of Xiamen University. Women scheduled for ultrasound-guided PMWA of uterine myomas will be eligible. 86 patients will be recruited and randomly assigned to either the intervention or control groups in a 1:1 ratio. The intervention group will undergo ultrasound-guided superior hypogastric plexus block (SHPB) combined with conscious sedation, while the control group will receive local anesthesia combined with conscious sedation. The primary outcome is the success rate of anesthesia, secondary outcomes include vasoactive drug consumption, acetaminophen consumption, sleep quality, sonographer satisfaction score, patient satisfaction score, the detained time in hospital, and adverse events. DiscussionsThis RCT represents the inaugural effort to specifically evaluate the safety and efficacy of ultrasound-guided SHPB combined with conscious sedation in patients undergoing ultrasound-guided PMWA of uterine myomas and will provide valuable evidence and insight into the analgesic management of this ambulatory surgery. Ethics and disseminationThis study has been approved by the Ethics Committee of the First Affiliated Hospital of Xiamen University (Scientific Research Ethics Review 2023, No. 139). The results will be submitted for publication in peer-reviewed journals.

Pre-emptive ultrasound-guided superior hypogastric plexus block in pelvic cancer surgeries: a randomized double-blinded study

BackgroundSuperior hypogastric plexus is a retroperitoneal plexus that receives visceral sensation from pelvic viscera. Superior hypogastric plexus block (SHPB) was used for chronic pelvic pain and recently studied for postoperative pain. We examined the safety and efficacy of preemptive anterior US-guided SHPB to reduce postoperative morphine consumption. Thirty-six patients undergoing pelvic cancer surgery were randomly divided into two equal groups; group S in which patients received anterior US-guided SHPB immediately after induction of general anesthesia and before skin incision using 20 ml bubivacaine 0.5%, group C control group in which 20 ml normal saline was given by the same technique. Patients of both groups received morphine via PCA postoperative and followed for 24 h. In both groups, we measured the total morphine consumption, VAS, vital signs, and side effects.ResultsDemographic data, duration, and type of surgery were comparable in both groups. Total 24 h morphine consumption in mg was significantly lower in group S (43.8 ± 2) than in group C (54.83 ± 2) with P value < 0.001. VAS was significantly lower in group S in all time intervals from 2 till 24 h postoperative. Side effects were minimal with no significant difference between both groups.ConclusionPreemptive US-guided SHPB is a relatively safe and effective method to reduce postoperative opioid demands after pelvic cancer surgeries.Trial registrationClinicalTrials.gov NCT04732234 in 1–2-2021.

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

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 &amp;lt; 0.05). Initial analgesic requirements were significantly higher in the non-SHPB group, as was total analgesic consumption during the hospital stay (p &amp;lt; 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.

Ultrasound versus Fluoroscopic-Guided Superior Hypogastric Plexus Block in Cancer Bladder: A Randomized Controlled Trial

BACKGROUND: Patients with advanced bladder cancer may suffer severe pelvic pain unresponsive to standard pharmacological therapy. AIM: This study assessed the feasibility, efficacy of ultrasoundguided (USG) versus fluoroscopy-guided (FG) superior hypogastric plexus block (SHPB) in bladder cancer pain management. METHODS: This randomized controlled study included 60 patients undergoing SHPB to manage pain in stages 3 and 4 bladder cancer patients from December 2020 to June 2021. They were randomly divided into two groups. Group Fluoro (n = 30) underwent FG-SHPB, while Group US (n = 30) underwent US-SHPB. The patients were assessed after 1 day and 1 and 3 months regarding pain intensity using visual analog score (VAS), daily morphine consumption, functional capacity, and quality of life (QoL) using the Short Form Health Survey-36. RESULTS: The procedure failed in 2 patients in each group. The procedure was significantly lengthier in the Fluor group than the US group (p &lt; 0.001). VAS scores decreased significantly in the two groups after 1 and 3 months and were significantly in US-SHBP after 3 months. Morphine consumption decreased significantly, and functional capacity and QoL improved significantly in both groups up to 3 months. The two groups were comparable in morphine consumption, functional capacity, and QoL. Position discomfort and back pain were more common in Fluor Group. CONCLUSION: USG SHPB is a feasible, safe, and effective analgesic procedure in patients with advanced bladder cancer suffering from severe pelvic pain. It is superior to the FG transdiscal approach regarding the duration of pain relief and improvement of functional capacity in addition to avoidance of position discomfort and back pain. REGISTRATION: Clinical Trials.gov (ID NCT05083702).

Analgesic Efficacy of Intraoperative Superior Hypogastric Plexus (SHP) Block during Abdominal Hysterectomy: A Systematic Review and Meta-Analysis of Controlled Trials.

Background and Objectives: Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. The objective of this research is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and nonrandomized comparative trials (NCTs) that have surveyed the analgesic benefits and morbidity of intraoperative superior hypogastric plexus (SHP) block (intervention) compared with no SHP block (control) during abdominal hysterectomy. Materials and Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Web of Science, PubMed, Scopus, and Embase were searched from inception until 8 May 2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias of RCTs and NCTs, respectively. In a random effects mode, the data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Five studies (four RCTs and one NCT) comprising 210 patients (SHP block = 107 and control = 103) were analyzed. The overall postsurgical pain score (n = 5 studies, MD = -1.08, 95% CI [-1.41, -0.75], p < 0.001), postsurgical opioid consumption (n = 4 studies, MD = -18.90 morphine milligram equivalent, 95% CI, [-22.19, -15.61], p < 0.001), and mean time to mobilization (n = 2 studies, MD = -1.33 h, 95% CI [-1.98, -0.68], p < 0.001) were significantly decreased in the SHP block group contrasted with the control arm. Nevertheless, there was no significant variance between both arms regarding operation time, intraoperative blood loss, postsurgical NSAID consumption, and hospital stay. There were no major side effects or sympathetic block-related aftermaths in both groups. Conclusions: During abdominal hysterectomy and receiving perioperative multimodal analgesia, the administration of intraoperative SHP block is largely safe and exhibits better analgesic effects compared to cases without administration of SHP block.

Efficacy of Pudendal Nerve Blocks and Ultrasound-Guided Superior Hypogastric Plexus Blocks for the Management of Refractory Interstitial Cystitis: A Case Series

Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by chronic pelvic, perineal, or bladder pain in addition to lower urinary tract symptoms. The etiology of this condition is not fully understood, which presents a challenge for effective therapeutic intervention. Current treatment guidelines recommend the use of multimodal pain management strategies including behavioral/non-pharmacologic, oral medications, bladder instillations, procedures, and major surgery. However, the safety and efficacy of these modalities vary, and there is currently no optimal treatment for the management of IC/BPS. The pudendal nerves and superior hypogastric plexus, which together mediate visceral pelvic pain and bladder control, are not addressed in the current guidelines but may serve as a therapeutic target. Here, we report improvements in pain, urinary symptoms, and functionality following bilateral pudendal nerve blocks and/or ultrasound-guided superior hypogastric plexus blocks in three patients with refractory IC/BPS. Our findings provide support for the use of these interventions in patients with IC/BPS unresponsive to prior conservative management.

A Case of Refractory Intractable Bladder Pain Syndrome Treated with Superior Hypogastric Nerve Chemical Neurolysis

Bladder pain syndrome (BPS) is a severely debilitating condition. BPS is a symptom complex affecting the urinary bladder, which is characterized by pelvic pain, urinary urgency, frequency, and nocturia. In this case report, we have presented a patient with BPS who was not responsive to conventional treatment and was managed successfully by diagnostic superior hypogastric plexus block followed by alcohol neurolysis.

Pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) after uterine artery embolization for symptomatic myomatosis

Pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) after uterine artery embolization for symptomatic myomatosis

Development of pre-procedure virtual simulation for challenging interventional procedures: an experimental study with clinical application.

BackgroundMost pain management techniques for challenging procedures are still performed under the guidance of the C-arm fluoroscope although it is sometimes difficult for even experienced clinicians to understand the modified three-dimensional anatomy as a two-dimensional X-ray image. To overcome these difficulties, the development of a virtual simulator may be helpful. Therefore, in this study, the authors developed a virtual simulator and presented its clinical application cases.MethodsWe developed a computer program to simulate the actual environment of the procedure. Computed tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data were used for the simulations. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, the authors searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified.ResultsFor the simulations, the CT DICOM data of patients who visited the outpatient clinic was used. When the patients revisited the clinic, images similar to the simulated images were obtained by manipulating the C-arm. Transforaminal epidural injection, which was difficult to perform due to severe spinal deformity, and the challenging procedures of the superior hypogastric plexus block and Gasserian ganglion block, were successfully performed with the help of the simulation.ConclusionsWe created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.

Superior hypogastric plexus (SHP) block during minimally invasive hysterectomy: A systematic review.

To systematically summarize the efficacy and safety of superior hypogastric plexus (SHP) block versus no SHP block among patients undergoing minimally invasive hysterectomy (MIH). Five information sources were screened from inception until 04.04.2022 and comprised the Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, and Web of Science. The inclusion criteria comprised (i) patients: individuals undergoing MIH, (ii) intervention: SHP block, (iii) Comparator: no SHP block, (iv) Outcomes: postoperative pain, postoperative opioid consumption, operation time, estimated intraoperative blood loss, hospital stay, and complications/toxicities, and (v) Study design: randomized controlled trials (RCTs) and non-randomized comparative trials published in peer-reviewed journals. Owing to the insignificant number of available studies, methodologic heterogeneity, and procedural variances, it was impossible to carry out a quantitative meta-analysis. Hence, the results of the included studies were only reported qualitatively (descriptively). Three studies (2 RCTs and 1 cohort study), comprising 210 patients (SHP=107 and non-SHP=103) were included in the qualitative synthesis. Overall, the included studies had a low risk of bias. The results showed that SHP block appeared largely safe and could reduce postoperative pain and opioid consumption. However, SHP block did not offer clinical benefits in terms of reduced operation time, intraoperative blood loss, and hospital stay compared with non-SHP block. Among patients undergoing MIH, this first ever systematic review showed that SHP block was safe and exhibited potential analgesic and opioid-sparing effects postoperatively. Additional RCTs are needed to carry out a powered meta-analysis and validate the findings.

Retrospective Evaluation of the Effectiveness of Superior Hypogastric Plexus Block in Chronic Pelvic Pain

Objective: Chronic pain is a cause that negatively affects the quality of life and functional capacity. As with most chronic pain syndromes, chronic pelvic pain requires a multimodal approach. Hypogastric plexus blockade and neurolysis may be effective in cases that do not respond to conservative treatments. In this study, we retrospectively evaluated the effect of hypogastric plexus blockade in patients with chronic pelvic pain. Methods: Forty patients with chronic pelvic pain (duration of pain&gt; 6 months) who underwent hypogastric plexus block under fluoroscopy were evaluated retrospectively. Neurolysis was performed after diagnostic block in 19 patients with chronic pelvic pain associated with pelvic cancer. Results: While the visual analogue scale (VAS) of the patients who underwent superior hypogastric block was 8.8 before the procedure, the VAS scores at 1 month, 3 months and 6 months after the procedure were recorded as 3.7, 2.2, and 1.1, respectively (p&lt;0.05). While the mean Oswestry Disabilty Index (ODI) score of the patients before the procedure was 46.0% (severe disability), it was recorded as 3% at the 6th month. The changes in VAS and ODI scores were statistically significant (p&lt;0.05). Conclusion: Hypogastric plexus blockade should be considered as an effective treatment option in the treatment of chronic pelvic pain. Keywords: Pelvic pain, nerve block, pain management, chemical neurolysis, fluoroscopy

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy.

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study

AimTo investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section.MethodsOne hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n = 65) and a control group (n = 50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non-steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated.ResultsThe SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P < 0.001) and required a significantly lower rescue dose of NSAID or opioids (P = 0.003, P < 0.05, respectively).ConclusionsSHP block may be an effective and safe pain relief treatment after a cesarean section.

Superior Hypogastric Plexus Block to Reduce Pain After Laparoscopic Hysterectomy: A Randomized Controlled Trial.

To assess whether a superior hypogastric plexus block performed during laparoscopic hysterectomy reduces postoperative pain. We conducted a multicenter, randomized, single-blind, controlled trial of superior hypogastric plexus block at the start of laparoscopic hysterectomy. Women undergoing a laparoscopic hysterectomy for any indication and with any other concomitant laparoscopic procedure were eligible. Standardized preoperative medications and incisional analgesia were provided to all patients. Our primary outcome was the proportion of patients with a mean visual analog scale (VAS) pain score lower than 4 within 2 hours postoperatively. Patients but not surgeons were blinded to the treatment group. Twenty-nine patients per group was estimated to be sufficient to detect a 38% absolute difference in the proportion of patients with a VAS score lower than 4 at 2 hours postoperatively, with 80% power and an α of 0.05. To account for loss to follow-up and potential imbalances in patient characteristics, we planned to enroll 50 patients per group. All analyses were intention to treat. Between January 2018 and February 2019, 186 patients were eligible; 100 were randomized and analyzed. Demographic and clinical characteristics were similar between the two groups. There was no significant difference in the proportion of patients with a mean VAS score lower than 4 within 2 hours postoperatively between patients who received a superior hypogastric plexus block (57%) and patients who did not (43%) (odds ratio 1.63, 95% CI 0.74-3.59; adjusted odds ratio 1.84, 95% CI 0.75-4.51). Among patients undergoing laparoscopic hysterectomy with standardized enhanced perioperative recovery pathways, superior hypogastric plexus block did not significantly reduce postoperative pain. ClinicalTrials.gov, NCT03283436.

Sympathetic Blocks

The autonomic nervous system (ANS) is the part of the nervous system that regulates involuntary functions. It is composed of the sympathetic and the parasympathetic nervous systems (SNS and PNS, respectively). The sympathetic nervous system, in addition to its vital role as part of the autonomic nervous system and the emergency response, is thought to be involved in numerous pathologic, painful conditions. These conditions are referred to as Sympathetically Mediated Pain (SMP). SMP is often considered a result of a vicious circle of events, which include changes in peripheral and central somatosensory processes. This assumption is based upon the observations that the pain is spatially correlated with signs of autonomic dysfunction, blocking the efferent sympathetic supply to the affected area would relieve the pain. Sympathetic blocks emerged as a way to help diagnose and treat several painful conditions, including complex regional pain syndrome (CRPS), phantom pain, neuralgias, herpes zoster, and even fibromyalgia. Additionally, sympathetic blockades have been used to improve perfusion, treat angina and malignant arrhythmias, and posttraumatic stress disorder (PTSD) symptoms. This review contains 1 table and 68 references. Key words: Sympathetic nervous system, sympathetically mediated pain, sympathetic blocks, neuropathic pain, chronic pain, stellate ganglion block, celiac plexus block, lumbar sympathetic block, superior hypogastric plexus block

A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain.

This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain. Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50-70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol. CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.

Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: an open-label pilot clinical trial

We aimed to investigate the effect of superior hypogastric plexus (SHP) block on pain relief and quality of life of patients with refractory endometriosis. Sixteen patients with refractory endometriosis underwent SHP block. The outcome measures included visual analogue scale (VAS) for chronic pelvic pain, VAS for dysmenorrhoea, and VAS for dyspareunia. The short-form endometriosis health profile (EHP-5) was used to measure quality of life. All the outcome measures were evaluated at weeks 0, 1, 4, 12 and 24. The mean baseline VAS scores significantly improved after the SHP block (p < .001 for all). The mean overall EHP-5 score also significantly improved from 54.3 ± 18.2 to 24.6 ± 13.3 (p < .001). The positive effects of SHP were not diminished over time. No serious adverse effect was noticed in any of the patients. Preliminary results suggest that SHP block could be used as an effective method in pain control and improvement of quality of life in refractory endometriosis. IMPACT STATEMENT What is already known on this subject? Safety and efficacy of SHP block in the treatment of CPP has been revealed in earlier investigations. However, the efficacy of SHP block for pain management in patients with refractory endometriosis has not been investigated in earlier investigations. What do the results of this study add? SHP block is an effective method for pain control and improvement of quality of life in patients with refractory endometriosis. The positive effects of this treatment did not diminish over 24-weeks follow-up of the study. No serious adverse effect was noticed in any of the patients. What are the implications of these findings for clinical practice and/or further research? Preliminary results suggest that SHP block could be used safely and effectively for controlling pain and improvement of quality of life in patients with refractory endometriosis.

Effectiveness of Superior Hypogastric Plexus Neurolysis for Pelvic Cancer Pain

Background: The superior hypogastric plexus block has been indicated for visceral pelvic pain treatment associated with malignancy. The first international report of this technique was published by Plancarte et al, in which a posterior percutaneous approach guided by fluoroscopy was described by applying neurolytic agents. The considerable variability in the data reported gave rise to 2 clinical approaches to those who performed the blockade early and those who executed it at a later stage of cancer. Objectives: The present study aims to provide more evidence regarding the effectiveness of this procedure. Study Design: This is a retrospective, longitudinal, descriptive study. Setting: The study was held at the pain unit service of the National Cancer Institute, Mexico City. Methods: A nonprobabilistic sample was selected; the data collection took place from January 2006 to December 2016 with patients diagnosed with pelvic pain, confirmed by imaging and biopsy studies. Patients who received any other type of intervention of the sympathetic axis, patients with a different approach than the classic or paravertebral technique, and patients with low survival rate were excluded. The Student t test was used to measure the significant difference between Visual Analog Scale (VAS) and morphine equivalent daily dose. The Cochran–Mantel– Haenszel test and the Gamma test were used to measure the association between the initial Karnofsky and blockade success. Results: The study included a total of 180 patients. The success rate was 59.4% at 1 month, 55.5% at 3 months, and 48.8% at 6 months. There was a sustained and significant VAS reduction that was 49.55% at 3 months. A significant reduction in opioid consumption of 12.55% was found at 3 months. There was no significant statistical evidence related to either opioid consumption or the functionality of the patient before the blockade as an influential variable in the success of the procedure. Limitations: Retrospective study, developed in a single center. Conclusions: Although opioids remain the cornerstone of cancer pain treatment, they produce many deleterious side effects. The superior hypogastric plexus neurolysis represents a reproducible and effective alternative in the management of pain in this group of patients. Key words: Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain, palliative care, analgesia, nerve block

A randomized controlled trial of ganglion impar block vs ganglion impar block with superior hypogastric plexus block for pain relief in patients of pelvic and perineal cancer

A randomized controlled trial of ganglion impar block vs ganglion impar block with superior hypogastric plexus block for pain relief in patients of pelvic and perineal cancer

Intraoperative superior hypogastric plexus block during cesarean section: a new technique for pain relief

Background: With increasing cesarean section rates all around the world, postoperative pain management is an important issue for all women. Good postoperative pain management helps to shorten the recovery period of the mother, improve the mother’s feeling of well-being, enable good breastfeeding, and provide optimum maternal–neonatal bonding.Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus block (SHPB) during cesarean section and describe the technique.Study design: This was a prospective quasi-experimental study that was conducted with 69 pregnant women at HSU. Kocaeli Derince Training and Research Hospital Obstetrics and Gynecology Clinics between 15 March 2018 and 15 August 2018. The case group included 34 healthy pregnant women who received SHPB (SHPB+) for postoperative pain relief during cesarean section under general anesthesia, and the control group included 35 healthy pregnant women who did not receive SHPB during cesarean section with general anesthesia (SHPB−). Postoperative 1st hour, 6th hour, 12th hour, 24th hour, and 48th hour visual analog scale (VAS) scores, the amount of analgesics used for pain relief, and the time of the postoperative first gas extraction were assessed.Results: The SHPB (+) group had lower 1st hour VAS scores than the SHPB (−) group (p < .001). The mean postoperative 1st hour VAS score of the SHPB (+) group was 4.74 ± 1.44, and was 6.80 ± 2.08 for the SHPB (−) group. There were no differences in postoperative 6th hour, 12th hour, 24th hour, and 48th hour VAS scores between the groups. When the SHPB (+) and SHPB (−) groups were compared for postoperative analgesic use and for the first postoperative gas extraction time, the SHPB (+) group had lower analgesic use (p < .001), and the SHPB (−) group had earlier gas extraction. The mean analgesic use in the SHPB (+) group was 2.29 ± 1.11 and it was 4 ± 0.84 in SHPB (−) group. The mean gas extraction time for the SHPB (−) group was 18.03 ± 7.2 h, and was 24.56 ± 8.56 h for the SHPB (+) group (p = .001).Conclusion: SHPB performed intraoperatively in cesarean section procedures with general anesthesia is a simple, easy approach to perform during open surgery with direct vision. SHPB helps postoperative pain management extensively with low postoperative VAS scores and low analgesic requirement.