Comparison of the Effects of Blocks on Postoperative Analgesia in Total Laparoscopic Hysterectomy Surgery

Comparison of the Effects of Superior Hypogastric Plexus Block and Erector Spinae Plane Block on Postoperative Analgesia in Total Laparoscopic Hysterectomy Surgery

Total laparoscopic hysterectomy (TLH) is one of the most commonly performed gynecological surgeries today. Various analgesic techniques are used for the management of postoperative pain. The aim of this study is to compare the postoperative analgesic efficacy of superior hypogastric plexus block (SHPB) and erector spinae plane block (ESPB) in patients undergoing TLH procedures.

This prospective, randomized, double-blind, single-center clinical trial aims to compare the postoperative analgesic efficacy of Superior Hypogastric Plexus Block (SHPB) and Erector Spinae Plane Block (ESPB) in patients undergoing total laparoscopic hysterectomy (TLH).

Following ethics committee approval (2022/514/220/10), the study was conducted between March 2022 and March 2023. Patients aged 18 to 65 years, classified as ASA physical status I-II and scheduled for elective TLH, were enrolled. Participants were randomly assigned into three groups using computer-generated randomization (n=30 per group): SHPB, ESPB, and Control. Both the anesthesiologist performing postoperative evaluations and the patients were blinded to group allocation.

All patients received general anesthesia in accordance with a standardized protocol.

ESPB was performed bilaterally at the T10 level under ultrasound guidance. SHPB was performed laparoscopically at the L5-S1 level after uterine removal. No regional block was applied in the control group.

Postoperative pain management was provided to all patients via patient-controlled analgesia (PCA). Pain levels were evaluated using the Visual Analog Scale (VAS) at postoperative 0, 30, 60, 90, and 120 minutes, and at 6, 12, and 24 hours.

This study aims to investigate whether SHPB provides more effective visceral analgesia compared to ESPB and whether this leads to reduced opioid requirements and improved patient satisfaction following TLH.

Inclusion Criteria:

• Female patients aged between 18 and 65 years
• Scheduled for elective total laparoscopic hysterectomy (TLH)
• Classified as American Society of Anesthesiologists (ASA) physical status I or II
• Able to provide written informed consent in accordance with the Declaration of Helsinki

Exclusion Criteria:

• Refusal to participate or inability to provide informed consent
• Body mass index (BMI) ≥ 35 kg/m²
• Inability to cooperate or follow instructions
• Presence of spinal or paravertebral deformity
• Known coagulopathy or use of anticoagulant therapy
• Known hypersensitivity or allergy to local anesthetic drugs used in the study
• Requirement for postoperative intensive care
• History of chronic opioid use (longer than four weeks prior to surgery)