Surgical Incision Site Local Anaesthetic Infiltration and Superior Hypogastric Plexus Block in Total Abdominal Hysterectomy Under General Anaesthesia- A Placebo-Controlled, Randomized Clinical Trial

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Volume 10, Issue 2

Abstract

Background: Total Abdominal hysterectomy is a major gynecological surgery that is associated with severe post-operative pain when operation is done under general anesthesia. Now a days multimodal analgesia methods is commonly used but till there is an insufficient control of pain. This present post operative pain controlled is linked to a different dose, drugs and frequency of administration with their adverse effects. There are always in search for proper analgesic modalities which are cost effective, long duration, technically easy to perform and are associated with less adverse effects. Local anesthetic infiltration into the surgical site commonly and less commonly the intra operative superior hypogastric plexus block used separately used as part of multimodal analgesia regimens to relieve pain. When this block used separately does not relieve both somatic and visceral component of pain. So, a placebo-controlled, randomized clinical trial was done with combined used of two local block provides acceptable pain relief and determined other analgesic consumption. Aim and Objective: The purpose of this study was to evaluate the effectiveness of combined superior hypogastric plexus block and surgical incision site local anaesthetic infiltration for total abdominal hysterectomy under general anaesthesia. Methods: This is a randomized controlled trial that was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU after obtaining approval from the Institution Review Board (IRB) and informed written consent from each individual. Total 60 women scheduled for TAH were allocated into two equal groups. Group A (n= 30) patients given SHP block (20 ml 0.25% plain bupivacaine) + Surgical incision site infiltration block (20 ml 0.25% plain bupivacaine) and Group B (n= 30) was given SHP block (20 ml 0.25% plain bupivacaine) + Surgical incision site infiltration block (20 ml of normal saline as placebo). The pain intensity using visual analog scale (VAS), hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), total dose of opioid administered in the first 24 hours, time to first analgesic requirement, both the patient and surgeon satisfaction were recorded. The statistical analysis was carried out using the Statistical Package for Social Sciences version 26 for Windows (SPSS Inc., Chicago, Illinois, USA). Qualitative Variables were expressed as frequency and percentage. Quantitative variables expressed as mean ± standard deviation. Students t test and Chi Square test (X2-test) was done to compare all the parameters between the groups. P values 0.05). Patients of Group-B had significantly higher VAS during the recovery ward, 2nd,4th, 6thand 12th hours compared with the Group-A (p

Keywords: Superior Hypogastric Plexus Block; Postoperative Pain Total Abdominal Hysterectomy; Visual Analogue Score; Opioids Consumption

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