Superior hypogastric plexus block along with preemptive troacar site infiltration: a novel multimodal strategy for pain control following laparoscopic myomectomy

Aim: to assess an impact of laparoscopic superior hypogastric plexus (SHP) block combined with preemptive troacar site infiltration on postoperative pain intensity following laparoscopic myomectomy.

Materials and Methods. The prospective randomized placebo-controlled double-blind clinical trial enrolled 207 patients undergoing laparoscopic myomectomy. Patients randomized into 3 groups with a target ratio of 1:1:1 were included in the study gradually, some (n = 9) were excluded from the study intraoperatively. Thus, the study included 198 patients: group 1 (n = 66) received standard systemic analgesia combined with troacar site infiltration and laparoscopic SHP block; group 2 (n = 65) received troacar site infiltration without SHP block; control group (group 3, n = 67) received standard systemic analgesia alone. The primary endpoint was presented by assessing pain intensity using the numeric rating scale (NRS) at 4 hours postoperatively. Secondary endpoints included NRS dynamics at 2, 6, 8, 12, and 24 hours postoperatively, time to first mobilization, opioid use, and pain quality assessment.

Results. Pain scores were significantly lower in the combined analgesia group (group 1) at all time points assessed up to 12 hours postoperatively and at discharge (p < 0.05). Opioid use in group 1 was also markedly reduced (4.5 %) compared to control group 3 (32.8 %; p = 0.001). Time to first mobilization was significantly shorter in group 1 compared to group 2 and group 3 (median 5 hours vs. 7 hours; p = 0.017). Deep pelvic (visceral) pain was more commonly reported in group 2 and group 3 than in group 1 (p = 0.021).

Conclusion. Preemptive multimodal analgesia combining troacar site infiltration with laparoscopic SHP block provides effective postoperative pain control, reduces opioid intake, and accelerates postoperative mobilization following laparoscopic myomectomy. This approach offers a promising strategy for improving recovery and minimizing opioid use in fertility-preserving gynecologic surgery.

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