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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Superior Hypogastric Plexus Block (SHPB) Group | Active Comparator | SHPB Group: In this group, patients received a superior hypogastric plexus block (SHPB) following total laparoscopic hysterectomy. After uterus removal and vaginal cuff closure, and before trocar removal, the injection site was identified laparoscopically. The block was performed in all patients by a single surgeon experienced in SHPB. |
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| Erector Spinae Plane Block Group | Active Comparator | ESPB Group: Patients in this group received erector spinae plane block (ESPB) during anesthesia maintenance after surgery. Patients were positioned in the lateral decubitus position. At the T10 level, the ultrasound probe was placed in the midline to identify spinous processes, then moved 2-3 cm laterally to visualize the transverse process, trapezius, and erector spinae muscles. The same procedure was performed on the opposite side. All blocks were performed by a single anesthesiologist experienced in ESPB. |
|
| Control Group | No Intervention | Control Group: Patients in this group did not receive any block and were managed with standard postoperative care only. This group served as the comparison group to evaluate the effects of the block interventions. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Superior Hypogastric Plexus Block (SHPB) | Procedure | Laparoscopic superior hypogastric plexus block with bupivacaine and lidocaine injection near sacral promontory. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total Tramadol Consumption | The total amount of tramadol administered via a patient-controlled analgesia (PCA) device within the first 24 hours after total laparoscopic hysterectomy. This measurement is used to compare the postoperative analgesic efficacy of superior hypogastric plexus block (SHPB) and erector spinae plane block (ESPB) with the control group receiving no block. Tramadol consumption is recorded in milligrams (mg) and extracted directly from PCA device logs. | Postoperative 0-24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Pain Intensity (VAS Scores) | Pain levels will be measured using the Visual Analog Scale (VAS), a 10 cm horizontal line labeled "no pain" at 0 cm and "worst imaginable pain" at 10 cm. Patients will indicate their pain intensity at postoperative time points (e.g., 1h, 6h, 12h, 24h). The score is determined by measuring the distance in centimeters from the "no pain" anchor to the patient's mark. Higher scores indicate greater pain intensity. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Macid Ordu, MD | Kartal Dr. Lütfi Kırdar Training and Research Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kartal Dr. Lütfi Kırdar Training and Research Hospital | Istanbul | 34862 | Turkey (Türkiye) |
There is no plan to share individual participant data due to institutional data protection policies and ethical considerations related to participant privacy.
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"This study uses a parallel design where participants are randomly assigned to one of three groups: Superior Hypogastric Plexus Block (SHPB), Erector Spinae Plane Block (ESPB), or Control group. Each group receives its respective intervention or no block in the control group. Outcomes are measured postoperatively to compare analgesic efficacy among groups."
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The study was conducted in a double-blind manner. Participants, care providers performing the block procedures, and outcome assessors were blinded to group assignments.
| Erector Spinae Plane Block (ESPB) | Procedure | Erector spinae plane block with ultrasound-guided injection of bupivacaine and lidocaine at T10 level. |
|
| Postoperative 0-24 hours |
| Time to First Rescue Analgesia | Duration from the end of surgery to the time the patient first requests additional analgesia beyond the standard postoperative regimen. | Postoperative 0-24 hours |
| Incidence of Postoperative Nausea and Vomiting (PONV) | The proportion of patients experiencing nausea and/or vomiting within the first 24 hours after surgery. | Postoperative 0-24 hours |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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