Superior hypogastric plexus block as a new method of pain relief after abdominal hysterectomy: double-blind, randomised clinical trial of efficacy

Objective: To determine whether superior hypogastric plexus block performed during abdominal hysterectomy decreases postoperative opioid consumption and pain.

Design: A randomised, double-blind, placebo-controlled, clinical trial.

Setting: A county hospital in Sweden.

Population: Sixty-eight women scheduled for total abdominal hysterectomy for a benign indication.

Methods: Twenty ml of ropivacaine 7.5 mg/ml or saline was injected retroperitoneally in the area of the superior hypogastric plexus during the hysterectomy. The participants were individually randomised to either intervention. The participants, caregivers, and those assessing the outcomes were blinded to group assignment.

Main outcome measures: The primary outcomes were postoperative opiate consumption and patients' self-assessment of pain (VAS scores). Secondary outcomes were mobilisation and side effects related to opiate consumption.

Results: The trial was completed with 38 women randomised to ropivacaine and 37 women randomised to saline. Analysis was performed on 35 women in the ropivaciane group and 33 women in the saline group. The postoperative opioid consumption was significantly lower in the ropivacaine group than in the placebo group (median 55.8 and 72.4 mg, respectively, P = 0.032). The proportion of women scoring VAS <4 at 2 hours after block was significantly higher in the ropivacaine group (63%) than in the placebo group (25%) (P = 0.015). No side effects or important adverse events occurred during the trial.

Conclusions: The superior hypogastric plexus block is a new method in this context and a promising contribution to postoperative pain treatment after abdominal hysterectomy.

Tweetable abstract: Superior hypogastric plexus block during abdominal hysterectomy lowers opioid consumption.