Superior hypogastric plexus block along with trocar 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 trocar site infiltration on postoperative pain intensity following laparoscopic myomectomy. Materials and Methods . The randomized double-blind clinical trial enrolled 198 patients undergoing laparoscopic myomectomy. Participants were randomized into three groups: the SHP block group (group 1, n = 66) received standard systemic analgesia combined with trocar site infiltration and laparoscopic SHP block; the trocar infiltration group (group 2, n = 65) received trocar 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 SHP block group (group 1) at all time points assessed up to 12 hours postoperatively and at discharge (p < 0.05). Opioid use in this group was also markedly reduced (4.5 %) compared to control group 3 (32.8 %; p = 0.001). Time to first mobilization was significantly shorter in the SHP block group 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 groups than in group 1 (p = 0.021). Conclusion . Preemptive multimodal analgesia combining trocar 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.