Superior Hypogastric Blockade for Postoperative Pain
Condition: Superior Hypogastric Plexus Block; Hysterectomy; Pain, Postoperative; Gynecologic Disease
MeSH terms: Genital Diseases, Female; Pain, Postoperative
Study type: Observational [Patient Registry]

Summary: 
      The primary indication for superior hypogastric (SHP) block is visceral pelvic pain, most
      commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate.
      Percutaneous SHP blocks should be done under guidance of ultrasonography, fluoroscopy,
      magnetic resonance or computed tomography. Because of the close proximity of SHP to major
      vessels, and structures like vertebral column (for posterior) and guts (for anterior) are
      being on the way of the needle, these percutaneous blocks are associated with serious
      complications. Performing SHP during hysterectomy surgery, gives advantages to rule out these
      complications by exploring the whole intraabdominal anatomy.

      The investigators' theory is to find out if SHP blocks (during pelvic surgery) are useful for
      decreasing VAS pain scores and opioid consumption for postoperative pain.
    

Detailed description: 
      Nerve blocks are frequently used in daily practice as an anesthetic and analgesia technique
      for surgery, postoperative pain and chronic pain. Total abdominal hysterectomy causes
      significant postoperative pain. Epidural blocks are frequently preferred for postoperative
      pain control, since most of the anesthetists are skilled with neuraxial blocks. However, an
      epidural catheter placement and epidural injections have some side effects and complications.

      Pelvis is innervated by thoracolumbar and sacral segments. Autonomic (sympathetic and
      parasympathetic) and somatic (motor and sensory) nerves provide innervation of pelvis. The
      sympathetic nervous system, which transmits nociceptive messages from the viscera to brain,
      plays an important role in the transmission of visceral pain. Generally, in order to block
      transmission of nociceptive information from the pelvic viscera to the spinal cord,
      interruption of sympathetic pathways will be necessary. The sympathetic nerve block on the
      sympathetic nervous system for the management of chronic pelvic pain has been proposed at
      three main levels: ganglion impar, hypogastric plexus and L2 lumbar sympathetic blocks. By
      following the pelvic anatomy, there could be an alternative way for acute pain relief for
      abdominal hysterectomy: superior hypogastric block.

      The superior hypogastric plexus lies retroperitoneally in front of L4 as a bunch of fibers.
      As these fibers descend, at the level of L5 they divide into the hypogastric nerves. The
      hypogastric nerves pass downward from L5-S1, following the concave curve of the sacrum and
      passing on each side of the rectum to form the inferior hypogastric plexus. These nerves
      continue their down¬ward course along each side of the bladder to provide innervation to the
      pelvic viscera and vasculature.

      The primary indication for superior hypogastric block (SHNB) is visceral pelvic pain, most
      commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate.
      Percutaneous SHP blocks can be done by using posterior approach (transdiscal) and
      paravertebral) and anterior techniques. All of these interventions should be done under
      guidance of ultrasonography, fluoroscopy, magnetic resonance or computed tomography. Because
      of the close proximity of SHP to major vessels, and structures like vertebral column (for
      posterior) and guts (for anterior) are being on the way of the needle, these percutaneous
      blocks are associated with complications.

      SHP block has been performed by anesthetists or surgeons in Kocaeli Derince Training and
      Research Hospital regularly since they have discovered the advantages of this block
      technique. Performing SHP block during hysterectomy surgery, gives advantages to rule out
      these complications by exploring the whole intraabdominal anatomy. Based on the complexity of
      the pelvic innervation, SHP blocks do not offer a total painless period like central
      neuraxial blocks for sure. If SHP block is performed in patients who do not have epidural
      catheters, it can be useful to decrease postoperative pain scores and opioid or NSAID
      consumption significantly.
    

Intervention name(s): superior hypogastric block
Intervention type(s): Procedure
Intervention description(s): superior hypogastric blockade during surgery
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The patients who are scheduled for elective hysterectomy under general anesthesia.
      
Keywords: superior hypogastric plexus block; hysterectomy; postoperative pain