Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies

Abstract

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.

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

“…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 ) .…”

Differences in Regional Anesthesia Utilization by Hospital Region in the United States

“…The top three procedures in terms of RA utilization rates were TSA, TKA and ACLR, each representing a common, high-volume orthopedic procedure with applicable upper extremity or lower extremity blocks, respectively. Regional techniques for TAH are evolving and represent a relatively new indication for the use of RA, with either quadratus lumborum block 21 , superior hypogastric block 22 , or transversus abdominis plane block 23 . For this reason, it is not surprising for RA utilization rates to be lower for this relatively newer indication than for more established surgical indications such as TSA 24 and TKA [25][26][27][28] .…”

Superior Hypogastric Plexus Block to Reduce Pain After Laparoscopic Hysterectomy

“…We used a SHPB technique similar to that described in the three prior studies examining SHPB at the time of abdominal or laparoscopic hysterectomy, all of which did identify some benefit of the block in reducing postoperative pain. 1,2,3 The technique is intended to deposit local anesthesia near to the superior hypogastric plexus, without intraneural injection, using anatomic landmarks to locate the plexus. The superior hypogastric plexus is a retroperitoneal midline structure anterior to the lower third of L5 and upper third of S1, immediately caudad to the aortic bifurcation and vena cava confluence, and overlying the sacral promontory.…”