This study aims to evaluate the analgesic effect of superior hypogastric plexus block combined with transversus abdominis plane block in abdominal hysterectomies.
Age ≥ 18 years.
American Society of Anesthesiology (ASA) physical status I-II.
Undergoing abdominal hysterectomies under general anesthesia (GA).
History of allergies to local anesthetics.
Body mass index (BMI) >35 kg/m2.
Opioid dependency.
Cognitive impairment.
Parallel
Superior hypogastric plexus block + Transverse abdominis plane
Other interventionPatients will receive superior hypogastric plexus block (SHPB) using 20ml of bupivacaine 0.25%+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%.
Superior hypogastric plexus block
Other interventionPatients 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%.
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.
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.
Degree of pain
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.
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).
Incidence of adverse events
Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, or any other complication will be recorded.
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