Superior hypogastric plexus block as a new method of pain relief after abdominal hysterectomy: double-blind, randomised clinical trial of efficacy.
OBJECTIVE
To determine whether superior hypogastric plexus block performed during abdominal hysterectomy decreases postoperative opioid consumption and pain.


METHODS
A randomised, double-blind, placebo-controlled, clinical trial.


METHODS
A county hospital in Sweden.


METHODS
Sixty-eight women scheduled for total abdominal hysterectomy for a benign indication.


METHODS
Twenty ml of ropivacaine 7.5 mg/ml or saline was injected retroperitoneally in the area of the superior hypogastric plexus during the hysterectomy. The participants were individually randomised to either intervention. The participants, caregivers, and those assessing the outcomes were blinded to group assignment.


METHODS
The primary outcomes were postoperative opiate consumption and patients' self-assessment of pain (VAS scores). Secondary outcomes were mobilisation and side effects related to opiate consumption.


RESULTS
The trial was completed with 38 women randomised to ropivacaine and 37 women randomised to saline. Analysis was performed on 35 women in the ropivaciane group and 33 women in the saline group. The postoperative opioid consumption was significantly lower in the ropivacaine group than in the placebo group (median 55.8 and 72.4 mg, respectively, P = 0.032). The proportion of women scoring VAS <4 at 2 hours after block was significantly higher in the ropivacaine group (63%) than in the placebo group (25%) (P = 0.015). No side effects or important adverse events occurred during the trial.


CONCLUSIONS
The superior hypogastric plexus block is a new method in this context and a promising contribution to postoperative pain treatment after abdominal hysterectomy.


CONCLUSIONS
Superior hypogastric plexus block during abdominal hysterectomy lowers opioid consumption.
Department of Gynaecology and Obstetrics, Gävle Hospital, Gävle, Sweden.
H
H
Rapp
Department of Anaesthesiology, Gävle Hospital, Gävle, Sweden.
S
S
Ledin Eriksson
Department of Gynaecology and Obstetrics, Gävle Hospital, Gävle, Sweden.
P
P
Smith
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D000077212:Ropivacaine; D013548:Sweden; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine
Analgesia; hysterectomy; nerve block; pain; randomised clinical trial; superior hypogastric plexus block