Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study

Peker, Hakan; Atasayan, Kemal; Peker, Berna Haliloglu; Kılıccı, Cetin

doi:10.3325/cmj.2021.62.472

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…The first is somatic pain from the skin incision, and the second is visceral pain from the exteriorization and straining of the uterus. The anterior branches of the T10–L1 (particularly T12–L1) spinal nerves should be blocked for somatic pain, and the superior/inferior hypogastric plexus branches should be inhibited for visceral pain [ 17 , 18 ]. While neuraxial anesthesia/analgesia can relieve both types of pain[ 19 ], abdominal wall blocks are usually only effective for somatic pain [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

et al. 2023

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Background Cesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study. Methods We analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18–45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h. Results There was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2–3] vs. TFPB group, 2 [0–2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2–4] vs. TFPB group 2 [0–3], p = 0.001). Conclusions In patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9–24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant.

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Section: Discussionmentioning

confidence: 99%

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

et al. 2023

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“…Several lines of investigations documented the analgesic benefits of SHP to patients with enduring pelvic pain, inclusive of malignant- (e.g., cancer) and benign (e.g., endometriosis)-related etiologies [ 6 , 22 ]. Within the fields of obstetrics and gynecology, SHP block has been displayed to adequately control postsurgical pain among women undergoing cesarean section [ 23 , 24 ], uterine artery embolization [ 25 ], and laparoscopic hysterectomy [ 26 , 27 , 28 ]. This present investigation further inflates the utilization landscape of the SHP block to incorporate a rationale for postsurgical pain relief after abdominal hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Intraoperative Superior Hypogastric Plexus (SHP) Block during Abdominal Hysterectomy: A Systematic Review and Meta-Analysis of Controlled Trials

et al. 2023

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Background and Objectives: Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. The objective of this research is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and nonrandomized comparative trials (NCTs) that have surveyed the analgesic benefits and morbidity of intraoperative superior hypogastric plexus (SHP) block (intervention) compared with no SHP block (control) during abdominal hysterectomy. Materials and Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Web of Science, PubMed, Scopus, and Embase were searched from inception until 8 May 2022. The Cochrane Collaboration tool and Newcastle–Ottawa Scale were used to evaluate the risk of bias of RCTs and NCTs, respectively. In a random effects mode, the data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Five studies (four RCTs and one NCT) comprising 210 patients (SHP block = 107 and control = 103) were analyzed. The overall postsurgical pain score (n = 5 studies, MD = −1.08, 95% CI [−1.41, −0.75], p < 0.001), postsurgical opioid consumption (n = 4 studies, MD = −18.90 morphine milligram equivalent, 95% CI, [−22.19, −15.61], p < 0.001), and mean time to mobilization (n = 2 studies, MD = −1.33 h, 95% CI [−1.98, −0.68], p < 0.001) were significantly decreased in the SHP block group contrasted with the control arm. Nevertheless, there was no significant variance between both arms regarding operation time, intraoperative blood loss, postsurgical NSAID consumption, and hospital stay. There were no major side effects or sympathetic block-related aftermaths in both groups. Conclusions: During abdominal hysterectomy and receiving perioperative multimodal analgesia, the administration of intraoperative SHP block is largely safe and exhibits better analgesic effects compared to cases without administration of SHP block.

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“…Here, our systematic review expands the utility horizon of SHP block to include a gynecologic indication for postoperative analgesia following MIH. SHP block has been previously illustrated to successfully manage postoperative pain among patients undergoing abdominal hysterectomy ( 5 , 19 ) and cesarean section ( 20 , 21 ) .…”

Section: Discussionmentioning

confidence: 99%

Superior hypogastric plexus (SHP) block during minimally invasive hysterectomy: A systematic review

Alomar¹,

Abuzaid²,

Abu‐Zaid³

et al. 2022

tjod

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To systematically summarize the efficacy and safety of superior hypogastric plexus (SHP) block versus no SHP block among patients undergoing minimally invasive hysterectomy (MIH). Five information sources were screened from inception until 04.04.2022 and comprised the Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, and Web of Science. The inclusion criteria comprised (i) patients: individuals undergoing MIH, (ii) intervention: SHP block, (iii) Comparator: no SHP block, (iv) Outcomes: postoperative pain, postoperative opioid consumption, operation time, estimated intraoperative blood loss, hospital stay, and complications/toxicities, and (v) Study design: randomized controlled trials (RCTs) and non-randomized comparative trials published in peer-reviewed journals. Owing to the insignificant number of available studies, methodologic heterogeneity, and procedural variances, it was impossible to carry out a quantitative meta-analysis. Hence, the results of the included studies were only reported qualitatively (descriptively). Three studies (2 RCTs and 1 cohort study), comprising 210 patients (SHP=107 and non-SHP=103) were included in the qualitative synthesis. Overall, the included studies had a low risk of bias. The results showed that SHP block appeared largely safe and could reduce postoperative pain and opioid consumption. However, SHP block did not offer clinical benefits in terms of reduced operation time, intraoperative blood loss, and hospital stay compared with non-SHP block. Among patients undergoing MIH, this first ever systematic review showed that SHP block was safe and exhibited potential analgesic and opioid-sparing effects postoperatively. Additional RCTs are needed to carry out a powered meta-analysis and validate the findings.

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Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study

Cited by 5 publications

References 19 publications

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

Analgesic Efficacy of Intraoperative Superior Hypogastric Plexus (SHP) Block during Abdominal Hysterectomy: A Systematic Review and Meta-Analysis of Controlled Trials

Superior hypogastric plexus (SHP) block during minimally invasive hysterectomy: A systematic review

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