A Novel Analgesic Method for Postoperative Pain Relief After Cesarean Section: Intraoperative Superior Hypogastric Block
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      Cesarean section is the most common inpatient surgical procedure in the United States with
      1.3 million cesarean deliveries performed in 2015. Cesarean section frequency is increasing
      rapidly in worldwide, especially in middle and high income countries.

      Postoperative pain is an expected outcome for patients following surgical procedures.
      Inadequate pain relief is still a common problem among hospitalized patients. Cesarean
      section ranked ninth for pain severity among 179 different surgical procedures.

      Multimodal pain therapy has been suggested for postoperative pain management after cesarean
      delivery. The most commonly used modalities are systemic administration of opioids, either by
      intramuscular injection or IV by patient-controlled analgesia, and neuraxial injection of
      opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific
      advantages and disadvantages.

      Superior hypogastric plexus blockade (SHB) has been shown an effective method for pain relıef
      after gynecologic procedures, it has been shown that SHP can be easily performed
      intraoperatively during hysterectomy procedure In this study, we aimed to investigate the
      efficacy of SHB performed intraoperatively for postoperative pain relief after cesarean
      section. To our knowledge, this is the first study to use SHB intraoperatively for pain
      relief after cesarean section in the literature.
    

Detailed description: 
      Cesarean section is a life-saving surgical operation performed during pregnancy and labor. It
      is the most common inpatient surgical procedure in the United States with 1.3 million
      cesarean deliveries performed in 2015. Cesarean section frequency is increasing rapidly in
      worldwide, especially in middle and high income countries.

      Postoperative pain is an expected outcome for patients following surgical procedures.
      Inadequate pain relief is still a common problem among hospitalized patients. A number of
      surveys report that 30%-70% of surgical patients experience moderate to severe pain (Breivik)
      At least 10.9% of women experience severe pain within 24 h after cesarean section. An
      analysis of 50523 patients from 105 hospitals questioning pain intensity on the first
      postoperative day revealed that cesarean section ranked ninth for pain severity among 179
      different surgical procedures.

      In this regard, multimodal pain therapy has been suggested for postoperative pain management
      after cesarean delivery. It requires the use of a combination of drugs with different
      mechanisms of action, and aims at achieving optimal analgesia through additive or synergistic
      drug action with small doses of opiates and decreased side effects. The most commonly used
      modalities are systemic administration of opioids, either by intramuscular injection or IV by
      patient-controlled analgesia, and neuraxial injection of opioid as part of a regional
      anesthetic for cesarean delivery. These techniques have specific advantages and
      disadvantages.

      Recently, superior hypogastric plexus blockade (SHB) has been shown an effective method for
      pain relıef after gynecologic procedures, i.e. hysterectomy (kaynak). The superior
      hypogastric plexus (SHP) is a retroperitoneal structure located bilaterally at the level of
      the lower third of the fifth lumbar vertebral body and upper third of the first sacral
      vertebral body at the sacral promontory in which it is most accessible to block for pelvic
      pain relief. Besides it can be performed either by fluoroscopy-guided, ultrasound
      (US)-guided, or CT-guided techniques, it has been shown that SHP can be easily performed
      intraoperatively during hysterectomy procedure ().

      In this study, we aimed to investigate the efficacy of SHB performed intraoperatively for
      postoperative pain relief after cesarean section. To our knowledge, this is the first study
      to use SHB intraoperatively for pain relief after cesarean section in the literature.
    

Intervention name(s): Intraoperative superior hypogastric plexus block
Intervention type(s): Procedure
Intervention description(s): SHP is situated anterior to L5-S1 vertebral bodies, caudal to the bifurcation of the aorta. An injection of 20 ml of bupivacaine 2,5 mg/ml or saline 9 mg/ml was done retroperitoneally in the area.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: prospective double-blinded randomized placebo controlled study
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: cesarean section; postoperative pain; superior hypogastric block