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Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies

Aytuluk, Hande G. MD*,†; Kale, Ahmet MD, PhD‡,§; Astepe, Bahar S. MD; Basol, Gulfem MD‡,§; Balci, Canan MD*,∥; Colak, Tuncay PhD

doi: 10.1097/AJP.0000000000000767
Original Articles

Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies.

Materials and Methods: A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30).

Results: There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9 min; P<0.05). All visual analogue scale score assessments were found to be statistically significantly lower in the SHP group (P<0.05). No complications related to the SHP blocks were observed.

Conclusions: Intraoperative SHP blocks in abdominal hysterectomies appear to be promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single SHP blocks provide adequate pain relief and reduce analgesic consumption, these blocks might have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations.

Departments of *Anaesthesiology and Reanimation

Gynaecology and Obstetrics, University of Health Sciences, Derince Training and Research Hospital

Department of Anatomy, Faculty of Medicine, Kocaeli University, Kocaeli

§Department of Gynaecology and Obstetrics, University of Health Sciences, Kartal Training and Research Hospital, Istanbul

Department of Anaesthesiology and Reanimation, Kutahya University of Health Sciences, Kutahya, Turkey

Clinical trial registration—NCT03428152.

H.G.A., A.K., G.B., and C.B.: study design and data analysis. H.G.A., A.K., B.S.A., and G.B.: patient recruitment and data collection. H.G.A., C.B., and T.C.: contributed with writing up of the first draft of the paper.

The authors declare no conflict of interest.

Reprints: Hande G. Aytuluk, MD, Department of Anaesthesiology and Reanimation; Derince Training and Research Hospital, 41900 Kocaeli, Turkey (e-mail:

Received May 8, 2019

Received in revised form August 22, 2019

Accepted September 8, 2019

Online date: September 17, 2019

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