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The primary indication for superior hypogastric plexus (SHP) block is visceral pelvic pain, most commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate. Per-cutaneous SHP blocks should be done under guidance of ultrasonography, fluoroscopy, magnetic resonance or computed tomography. During minimally invasive laparoscopic surgery, percutaneous technique can be done under the guidance of cameras.
Laparoscopic surgeries have many advantages over open surgeries. Laparoscopic procedures are mostly preferred for surgical treatment of gynecologic diseases, because of best cosmetically results, less perioperative complications, early recovery, and less postoperative pain.
There are many undesirable effects of systemic reactions to the pain. Accordingly, multi-modal analgesic approach (including nerve blocks) for postoperative acute pain can decrease the side effects of the drugs (especially opioids) significantly.
The primary indication for superior hypogastric plexus (SHP) block is visceral pelvic pain, most commonly from malignancy of the ovary, uterus, cervix, bladder, rectum or prostate. Per-cutaneous SHP blocks should be done under guidance of ultrasonography, fluoroscopy, magnetic resonance or computed tomography. During minimally invasive laparoscopic surgery, per-cutaneous technique can be done under the guidance of cameras.
SHP block has been performed by anesthetists or surgeons in Kocaeli Derince Training and Research Hospital regularly since they have discovered the advantages of this block technique. SHP can be useful to decrease postoperative pain scores and opioid or NSAID consumption significantly.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hypo | The participants with a superior hypogastric block |
| |
| NoHypo | The participants without a superior hypogastric block; the patients with an epidural catheter, who receive a different block technique (ie: TAP block), or who are unsuitable for SHP block (ie: if retroperitone is opened intraoperatively by the surgeon) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Procedure/Surgery: superior hypogastric block | Procedure | superior hypogastric blockade during surgery |
|
| Measure | Description | Time Frame |
|---|---|---|
| postoperative pain scores (PACU) | Patients' pain scores will be scored with a 10 cm Visual Analogue Scale (VAS). Each will be scored between 0-10 (0: no pain; 10: worst pain ever) | 1 hour (postoperatively) |
| postoperative opioid/NSAID consumption (PACU) | nonsteroid antiinflammatory drugs (NSAID) or opioid drugs that are applied to patients will be noted down. | 1 hour (postoperatively) |
| rescue analgesic time | Time to first analgesic demand at gynecology ward (after transfer from PACU to gynecology ward) | 48 hours (first analgesic demand time will be noted down) |
| postoperative pain scores (ward) | Patients' pain scores will be scored with a 10 cm Visual Analogue Scale (VAS). Each will be scored between 0-10 (0: no pain; 10: worst pain ever) | 48 hours (postoperatively) |
| postoperative opioid/NSAID consumption (ward) | NSAID or opioid drugs that are applied to patients will be noted down. Target VAS score for NSAID is >4; if there is no response to NSAID and pain is worsening opioid drugs will be applied | 48 hours (total) |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative hemodynamics | (If the patient is received a SHP block intraoperatively) post-block hemodynamical parametres will be noted down | from SHP block to the end of the surgery (approximately 15 min) |
| length of stay |
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Inclusion Criteria:
Exclusion Criteria:
patients who are scheduled for hysterectomy
The patients who are scheduled for elective laparoscopic hysterectomy under general anesthesia.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hande Aytuluk, MD | Contact | +902623198000 | handegrbz@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Hande Aytuluk, MD | Derince Training and Research Hospital | Principal Investigator |
| Ahmet Kale, Prof | Derince Training and Research Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Derince Training and Research Hospital | Recruiting | Kocaeli | Derince | 41900 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28381342 | Result | Song T, Kim MK, Jung YW, Yun BS, Seong SJ, Choi CH, Kim TJ, Lee JW, Bae DS, Kim BG. Minimally invasive compared with open surgery in patients with borderline ovarian tumors. Gynecol Oncol. 2017 Jun;145(3):508-512. doi: 10.1016/j.ygyno.2017.03.019. Epub 2017 Apr 2. | |
| 25814108 | Result | Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am. 2015 Apr;95(2):301-18. doi: 10.1016/j.suc.2014.10.002. Epub 2015 Jan 24. |
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The investigators do not prefer to share the study plan and records.
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Jun 9, 2018 | |
| Unrelease | Jul 9, 2018 | |
| Release | Jul 22, 2018 | |
| Reset | Jan 16, 2019 | |
| Release | Feb 13, 2019 | |
| Reset | May 24, 2019 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Jun 9, 2018 | Jul 9, 2018 | |||
| Jul 22, 2018 |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D005831 | Genital Diseases, Female |
| D010146 | Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |
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length of hospital stay time will be noted
| 3-5 days (expected) |
| complications due to SHP block | intra/postoperative complications will be noted. (ie: intra-vascular local anesthetic injection, vascular puncture, hemodynamical changes after injection,.. ) | 3-5 days (from surgery to discharge from the hospital) |
| Gulfem Basol, MD |
| Derince Training and Research Hospital |
| Study Chair |
| 27208713 | Result | Sindt JE, Brogan SE. Interventional Treatments of Cancer Pain. Anesthesiol Clin. 2016 Jun;34(2):317-39. doi: 10.1016/j.anclin.2016.01.004. |
| 12945023 | Result | Erdine S, Yucel A, Celik M, Talu GK. Transdiscal approach for hypogastric plexus block. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):304-8. doi: 10.1016/s1098-7339(03)00191-3. |
| 30165185 | Derived | Aytuluk HG, Kale A, Basol G. Laparoscopic Superior Hypogastric Blocks for Postoperative Pain Management in Hysterectomies: A New Technique for Superior Hypogastric Blocks. J Minim Invasive Gynecol. 2019 May-Jun;26(4):740-747. doi: 10.1016/j.jmig.2018.08.008. Epub 2018 Aug 28. |
| Jan 16, 2019 |
| Feb 13, 2019 | May 24, 2019 |
| D012816 | Signs and Symptoms |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |