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This study aims to evaluate the analgesic effect of superior hypogastric plexus block combined with transversus abdominis plane block in abdominal hysterectomies.
Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. Inadequate postoperative analgesia can lead to postoperative complications and can delay functional recovery. Accordingly, a multimodal regimen for postoperative pain management is recommended.
The transverse abdominis plane (TAP) block is a regional block anesthetizing the nerves (T10 to L1) hence covering the lower abdominal wall.
The superior hypogastric plexus (SHP), which lies retroperitoneally in front of the L5 and S1 vertebrae, provides innervation to the pelvic viscera. The blockade of SHP is well-recognized for the management of chronic pelvic pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group S | Experimental | Patients will receive superior hypogastric plexus block (SHPB) using 20ml of bupivacaine 0.25%+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%. |
|
| Group C | Active Comparator | Patients will receive superior hypogastric plexus block (SHPB) using 20ml of saline 0.9% (sham)+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Superior hypogastric plexus block + Transverse abdominis plane | Other | Patients will receive superior hypogastric plexus block (SHPB) using 20ml of bupivacaine 0.25%+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%. |
| Measure | Description | Time Frame |
|---|---|---|
| Time to the first request for the rescue analgesia | Time to the first request for the rescue analgesia will be recorded from the end of surgery to first dose of morphine administrated. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Total morphine consumption | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) > 3 to be repeated after 30 min if pain persists until the NRS < 4. | 24 hours postoperatively |
| Degree of pain |
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Inclusion Criteria:
Exclusion Criteria:
Women undergoing abdominal hysterectomies
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mohammed S Elsharkawy, MD | Contact | 00201148207870 | mselsharkawy@med.tanta.edu.eg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Recruiting | Tanta | El-Gharbia | 31527 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Superior hypogastric plexus block | Other | Patients will receive superior hypogastric plexus block (SHPB) using 20ml of saline 0.9% (sham)+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%. |
|
Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at post-anesthesia care unit (PACU), 2, 4, 6, 8, 12, 18, and 24 h postoperatively.
| 24 hours postoperatively |
| Quality of recovery | The quality of recovery (QoR-15) score will be assessed 24 hours postoperatively. This tool consists of 15 questions, each scored on a 10-point scale, yielding a maximum of 150. It encompasses five domains; physical comfort (questions 1-4, 13), emotional state (questions 9, 10, 14, 15), psychological support (questions 6, 7), physical independence (questions 5, 8), and pain (questions 11, 12). | 24 hours postoperatively |
| Incidence of adverse events | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, or any other complication will be recorded. | 24 hours postoperatively |