Superior hypogastric plexus nerve block in minimally-invasive gynaecology: a double-blind randomised controlled trial

Clinical trial to evaluate the efficacy of a superior hypogastric plexus nerve block with 10ml 0.75% ropivacaine in reducing opiate requirements in the first 24 hours after minimally invasive gynaecological surgery. This was a double-blind RCT at a single institution. Primary outcome was the total opiate use in first 24h after surgery (in morphine milliequivalents). Secondary outcome was patient pain measured on a visual analogue scale (1 to 10) at 1, 2, 6, 12 and 24-hours post-surgery. Patients were randomised over a 5-month period, March to July 2020. 27 patients were randomised to receive a nerve block and 23 to the control. There were no significant demographic or intraoperative differences between the two groups. 27 patients were randomized to receive a nerve block and 23 to the control. There was a difference of -21.8 MME in the block group compared to the no-block group (95% CI -38.2 – -5.5, p=0.008). This correlated to a 38% reduction in opioid use in the block group. The mean opioid use in block patients was 33.1 MME (95% CI, 24.2 – 41.9) and in the non-block group 54.9 MME (95% CI, 40.7 – 69.1). For the SHPB group opioid use ranged from 1.0-76.5 MME with an interquartile range (IQR) of 37 (14-51). For the control group the range was 7.5- 113.5 MME with a higher IQR of 60 (28-88). Pairwise comparisons of mean pain scores over the 24 hours showed a lower pain score with a nerve block of 1.8 (95% CI 1.5 – 2.1) compared to no-block of 2.6 (95% CI 2.3 – 2.9) No adverse effects of local anesthetic toxicity, nerve injury or bowel/vascular injury were noted in any patient.

本研究旨在评估在微创妇科手术后24小时内，使用10毫升0.75%罗哌卡因对高位迷走神经丛进行阻滞的疗效，以降低阿片类药物的需求。该研究为单中心双盲随机对照试验。主要结局指标为手术后24小时内阿片类药物的总使用量（以吗啡当量计算）。次要结局指标为患者术后1小时、2小时、6小时、12小时和24小时在视觉模拟评分量表（1至10分）上的疼痛评分。患者在2020年3月至7月期间，历时5个月的时段内进行随机分组，27名患者接受神经阻滞治疗，23名患者作为对照组。两组患者在人口统计学或术中差异方面均无显著性。接受神经阻滞的患者组与未接受阻滞的患者组相比，阿片类药物使用量差异为-21.8吗啡当量（95%置信区间-38.2至-5.5，p=0.008），这相当于阻滞组阿片类药物使用量减少了38%。接受阻滞治疗的患者的平均阿片类药物使用量为33.1吗啡当量（95%置信区间，24.2至41.9），而未接受阻滞组为54.9吗啡当量（95%置信区间，40.7至69.1）。对于高位迷走神经丛阻滞组，阿片类药物使用量范围在1.0至76.5吗啡当量之间，四分位距（IQR）为37（14-51）。对于对照组，范围在7.5至113.5吗啡当量之间，IQR较高，为60（28-88）。24小时内平均疼痛评分的双向比较显示，与未接受阻滞组相比，接受神经阻滞组的疼痛评分为1.8（95%置信区间1.5至2.1），而未接受阻滞组的疼痛评分为2.6（95%置信区间2.3至2.9）。在任何患者中均未观察到局部麻醉剂毒性、神经损伤或肠道/血管损伤等不良事件。