Aim: To evaluate the analgesic effect of superior hypogastric plexus (SHP) area infiltration with 20 ml bupivacaine0.5% on post total abdominal hysterectomy (TAH) pain.
Patients and Methods: This a prospective randomized, double blind, placebo controlled study, conducted at Benha University Hospital, including sixty women undergoin TAH, thirty women received 20 ml bupivacaine 0.5% and thirty women received 20 ml saline infiltrated in SHP area at end of TAH. Main outcomes measures were total cumulative Nalbuphine consumption and post TAH pain using visual analogue scale (VAS), as well as nausea, vomiting, other analgesic requirements, time spent in post anaesthesia care unit (PACU), time to get out of bed.
Results: The mean post TAH pain VAS score at PACU, two, six hours postoperatively were significantly lower in bupivacaine group (P = 0.016, P = 0.0006, P = 0.0008). Total Nalbuphine consumption were significantly lower in bupivacaine group at six, twenty four hours, postoperatively and at discharge (P < 0.0001, P < 0.0001, P < 0.0001). Also total nonsteroidal anti-inflammatory drugs (NSAIDs) consumption were lower in bupivacaine at twenty four hours postoperatively as well as at discharge (P < 0.0001, P = 0.0006), nausea, vomiting, and time to first flatus were significantly lower in bupivacaine group (P = 0.02, P = 0.02, P = 0.0068).
Conclusion: Post TAH infiltration of SHP area with 20 ml bupivacaine 0.5% reduce postoperative pain and total cumulative opioid and NSAIDs analgesics as well as promotes early gut recovery after TAH.
Keywords: Total abdominal hysterectomy, visual analogue score, bupivacaine, local anaesthesia, opioids consumption.
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