Superior Hypogastric Plexus Blockade in Laparoscopic Hysterectomy

Study Overview
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Brief Summary
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The primary indication for superior hypogastric plexus (SHP) block is visceral pelvic pain, most commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate. Per-cutaneous SHP blocks should be done under guidance of ultrasonography, fluoroscopy, magnetic resonance or computed tomography. During minimally invasive laparoscopic surgery, percutaneous technique can be done under the guidance of cameras.

Detailed Description
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Laparoscopic surgeries have many advantages over open surgeries. Laparoscopic procedures are mostly preferred for surgical treatment of gynecologic diseases, because of best cosmetically results, less perioperative complications, early recovery, and less postoperative pain. There are many undesirable effects of systemic reactions to the pain. Accordingly, multi-modal analgesic approach (including nerve blocks) for postoperative acute pain can decrease the side effects of the drugs (especially opioids) significantly. The primary indication for superior hypogastric plexus (SHP) block is visceral pelvic pain, most commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate. Per-cutaneous SHP blocks should be done under guidance of ultrasonography, fluoroscopy, magnetic resonance or computed tomography. During minimally invasive laparoscopic surgery, per-cutaneous technique can be done under the guidance of cameras. 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. SHP can be useful to decrease postoperative pain scores and opioid or NSAID consumption significantly.

Official Title
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Efficacy of Intraoperative Superior Hypogastric Plexus Blockade for Postoperative Pain in Laparoscopic Hysterectomy

Conditions
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Superior Hypogastric Plexus Block, Hysterectomy, Minimally Invasive Surgery, Laparoscopy, Pain, Postoperative, Gynecologic Disease

Intervention / Treatment
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* Procedure: Procedure/Surgery: superior hypogastric block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I - II Elective laparoscopic hysterectomy Exclusion Criteria: ASA III Different kind of surgery Known allergy to local anesthetic drugs Different analgesia protocol (ie: epidural, TAP block,..) Refusal of the patient

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hypo<br>The participants with a superior hypogastric block | Procedure: Procedure/Surgery: superior hypogastric block<br>* superior hypogastric blockade during surgery<br>|
| NoHypo<br>The participants without a superior hypogastric block; the patients with an epidural catheter, who receive a different block technique (ie: TAP block), or who are unsuitable for SHP block (ie: if retroperitone is opened intraoperatively by the surgeon) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain scores (PACU) | Patients' pain scores will be scored with a 10 cm Visual Analogue Scale (VAS). Each will be scored between 0-10 (0: no pain; 10: worst pain ever) | 1 hour (postoperatively) | 
| postoperative opioid/NSAID consumption (PACU) | nonsteroid antiinflammatory drugs (NSAID) or opioid drugs that are applied to patients will be noted down. | 1 hour (postoperatively) | 
| rescue analgesic time | Time to first analgesic demand at gynecology ward (after transfer from PACU to gynecology ward) | 48 hours (first analgesic demand time will be noted down) | 
| postoperative pain scores (ward) | Patients' pain scores will be scored with a 10 cm Visual Analogue Scale (VAS). Each will be scored between 0-10 (0: no pain; 10: worst pain ever) | 48 hours (postoperatively) | 
| postoperative opioid/NSAID consumption (ward) | NSAID or opioid drugs that are applied to patients will be noted down. Target VAS score for NSAID is >4; if there is no response to NSAID and pain is worsening opioid drugs will be applied | 48 hours (total) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative hemodynamics | (If the patient is received a SHP block intraoperatively) post-block hemodynamical parametres will be noted down | from SHP block to the end of the surgery (approximately 15 min) | 
| length of stay | length of hospital stay time will be noted | 3-5 days (expected) | 
| complications due to SHP block | intra/postoperative complications will be noted. (ie: intra-vascular local anesthetic injection, vascular puncture, hemodynamical changes after injection,.. ) | 3-5 days (from surgery to discharge from the hospital) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Superior Hypogastric Plexus Block, Hysterectomy, Minimally invasive surgery, Laparoscopy, Pain, Gynecologic Disease