The Efficacy of Superior Hypogastric Blockade for Postoperative Pain
Conditions: Superior Hypogastric Plexus Block, Hysterectomy, Pain, Postoperative, Gynecologic Disease
Sponsor: Derince Training and Research Hospital

Superior Hypogastric Blockade for Postoperative Pain 
Hande Gurbuz Aytuluk, MD1,2, Ahmet Kale, MD, Prof3, Gulfem Basol, MD3, Canan Balci, MD, 
Assoc. Prof1 
 
1: University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department 
of Anesthesiology and Reanimation, 41900 Derince, Kocaeli, Turkey. 
2: Kocaeli University School of Medicine, Department of Anatomy (PhD student), Kocaeli, 
Turkey. 
3: University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department 
of Gynecology and Obstetrics, 41900 Derince, Kocaeli, Turkey. 
 
Trial registration: NCT03428152 
 
Date of the document:  
Initial Release: January 30th, 2018 
Study Start (Actual): February 9th, 2018 
Study Completion (Actual): July 24th, 2018 
Last Update: February 17th, 2019 
 
 

Objectives: Total abdominal hysterectomy cause significant postoperative pain. 
Intraoperative superior hypogastric block may be an alternative way for acute postoperative 
pain relief in patients undergoing hysterectomy. This study’s objective is to evaluate the effect 
of intraoperative superior hypogastric blocks on postoperative pain management. 
Design and Subjects: Sixty female patients who underwent elective abdominal hysterectomy 
were included in the prospective observational cohort study. Patients were divided into two 
groups: Patients who had intraoperative SHP block (Hypo; n=30), and patients who did not 
have intraoperative SHP block (No-Hypo; n=30).  
Methods: Total sample size was determined by performing a power analysis. Thirty patients 
were recruited for each group (CI: 95%). Patients were divided into two groups: Patients who 
had intraoperative SHP block (Hypo; n=30), and patients who did not have intraoperative SHP 
block (No-Hypo; n=30). Patients who were under the age of 18, underwent epidural 
catheterization and / or additional pain management modalities (transversus abdominis plane 
blocks, local wound site infiltration, quadratus lumborum block... etc.), operated for 
malignancy, operated by using a different surgical approach (i.e. vaginal hysterectomy), and 
prescribed preoperative antidepressants or gabapentinoids were excluded from the study.  
Duration of operation was calculated in minutes from incision to skin to skin closure. 
Postoperative pain assessed by 10 cm Visual Analogue Scale (VAS). Pain scores were assessed 
in post-anesthesia care unit (PACU), and at ward (at 1st, 6th, 12th, 24th and 48th hours). Rescue 
analgesic time was calculated in minutes as the time interval between the last administration 
of analgesic intraoperatively and the first analgesic demand in surgical ward. Postoperative 
nausea and vomiting, hospital stay time, total analgesic requirements of patients in PACU and 
in surgical ward were recorded.  

Statistical Analysis: Study data were analyzed by using IBM SPSS Statistics Version 24. Mann 
Whitney-U test was used for numerical values which do not meet normal distribution, 
independent sample t test was used for body mass index, Chi-square test was used to analyze 
the discrete variables, and p value <0.05 was considered statistically significant. Friedman’s 
test /post-hoc test was used to analyze the repeated measures, and Wilcoxon signed-rank test 
was used for paired comparison of the repeated measures. Bonferroni corrected significance 
was considered as p<0,0033.  
Ethical Consideration: This study was approved by the Kocaeli University's Institutional 
Review Board (IRB KÜGOKAEK #2017/285/14.22) and written informed consent was obtained 
from all subjects participating in the trial. All procedures followed were in accordance with 
the ethical standards of the responsible committee on human experimentation and with the 
Helsinki Declaration of the World Medical Association.