Total laparoscopic hysterectomy (TLH) is one of the most commonly performed gynecological surgeries today. Various analgesic techniques are used for the management of postoperative pain. The aim of this study is to compare the postoperative analgesic efficacy of superior hypogastric plexus block (SHPB) and erector spinae plane block (ESPB) in patients undergoing TLH procedures.
This prospective, randomized, double-blind, single-center clinical trial aims to compare the postoperative analgesic efficacy of Superior Hypogastric Plexus Block (SHPB) and Erector Spinae Plane Block (ESPB) in patients undergoing total laparoscopic hysterectomy (TLH). Following ethics committee approval (2022/514/220/10), the study was conducted between March 2022 and March 2023. Patients aged 18 to 65 years, classified as ASA physical status I-II and scheduled for elective TLH, were enrolled. Participants were randomly assigned into three groups using computer-generated randomization (n=30 per group): SHPB, ESPB, and Control. Both the anesthesiologist performing postoperative evaluations and the patients were blinded to group allocation. All patients received general anesthesia in accordance with a standardized protocol. ESPB was performed bilaterally at the T10 level under ultrasound guidance. SHPB was performed laparoscopically at the L5-S1 level after uterine removal. No regional block was applied in the control group. Postoperative pain management was provided to all patients via patient-controlled analgesia (PCA). Pain levels were evaluated using the Visual Analog Scale (VAS) at postoperative 0, 30, 60, 90, and 120 minutes, and at 6, 12, and 24 hours. This study aims to investigate whether SHPB provides more effective visceral analgesia compared to ESPB and whether this leads to reduced opioid requirements and improved patient satisfaction following TLH.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
90
Laparoscopic superior hypogastric plexus block with bupivacaine and lidocaine injection near sacral promontory.
Erector spinae plane block with ultrasound-guided injection of bupivacaine and lidocaine at T10 level.
Kartal Dr. Lütfi Kırdar Training and Research Hospital
Istanbul, Turkey (Türkiye)
Total Tramadol Consumption
The total amount of tramadol administered via a patient-controlled analgesia (PCA) device within the first 24 hours after total laparoscopic hysterectomy. This measurement is used to compare the postoperative analgesic efficacy of superior hypogastric plexus block (SHPB) and erector spinae plane block (ESPB) with the control group receiving no block. Tramadol consumption is recorded in milligrams (mg) and extracted directly from PCA device logs.
Time frame: Postoperative 0-24 hours
Postoperative Pain Intensity (VAS Scores)
Pain levels will be measured using the Visual Analog Scale (VAS), a 10 cm horizontal line labeled "no pain" at 0 cm and "worst imaginable pain" at 10 cm. Patients will indicate their pain intensity at postoperative time points (e.g., 1h, 6h, 12h, 24h). The score is determined by measuring the distance in centimeters from the "no pain" anchor to the patient's mark. Higher scores indicate greater pain intensity.
Time frame: Postoperative 0-24 hours
Time to First Rescue Analgesia
Duration from the end of surgery to the time the patient first requests additional analgesia beyond the standard postoperative regimen.
Time frame: Postoperative 0-24 hours
Incidence of Postoperative Nausea and Vomiting (PONV)
The proportion of patients experiencing nausea and/or vomiting within the first 24 hours after surgery.
Time frame: Postoperative 0-24 hours
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