A Pilot Randomized Controlled Trial Comparing Presacral Nerve Block to Sham Block in Total Laparoscopic Hysterectomy

Abstract

Objective:

This study sought to determine if a presacral nerve (PSN) block affects early postoperative pain, opioid use, and rates of urinary retention after laparoscopic hysterectomy.

Materials and Methods:

Patients who had elective total laparoscopic hysterectomy (TLH) without histories of chronic pain or opioid use were assigned randomly to either a PSN block of 10 mL of 0.5% bupivacaine or a sham block of 10 mL normal saline post surgery. The primary outcome was pain assessed on a visual analogue scale (VAS) at 3 hours postoperatively and secondary outcomes included pain at 1, 2, and 3 hours, and opioid use post surgery. Participant recruitment was halted due to cancellation of elective surgeries during the COVID-19 pandemic, and, therefore, the data of the patients who were already recruited, was analyzed as an interim analysis for a pilot study design.

Results:

Thirty-four patients were recruited, with 21 in the intervention group and 13 in the sham-block group. Operative times were similar between both groups. Postoperative pain (measured at 1, 2, and 3 hours post surgery) was not significantly different between the 2 groups. Fewer patients in the PSN group required fentanyl for pain control in the recovery room (28.6% versus 53.8%; p = 0.041), although there was no statistically significant difference in terms of overall opioid consumption. There were no complications related to PSN-block administration.

Conclusions:

PSN block appears to be feasible and may contribute to decreased opioid use following laparoscopic hysterectomy. As participant recruitment was halted, a robust, well-powered, randomized control trial is necessary. (J GYNECOL SURG 20XX:000)