Role of paracervical block in reducing postoperative pain after laparoscopic hysterectomy: A systematic reivew and meta-analysis of randomized controlled trials. - 10/05/21

Doi : 10.1016/j.jogoh.2021.102156

Haitham Badran ^a, Ahmed Mohamed Abdelhakim ^b,^⁎ , Kareem Labib ^c, Mariam Salah Mohamed ^d, Doaa Helmy Yousef ^d, Hiba Maarouf ^e, Saeed Baradwan ^f, Sumayyah ALJuaid ^g, Ahmed Ghazi ^h, Mostafa Hassanien Hassanien Bakr ⁱ, Ahmed M. Abbas ^j, Doaa M. Saleh ^d
^a Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
^b Kasralainy, Faculty of Medicine, Cairo University, Cairo, Egypt
^c Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
^d Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University for Girls, Cairo, Egypt
^e REProVita Fertility Center, Recklinghausen, Germany
^f Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
^g Department of Obstetrics and Gynecology, Security Forces Hospital, Makkah, Saudi Arabia
^h Department of Obstetrics and Gynecology, Jeddah University, Jeddah, Saudi Arabia
ⁱ Department of Anaesthesia and Intensive care, Faculty of Medicine, Assiut University, Assiut, Egypt
^j Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt

^⁎Corresponding author: Institution: Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo - Egypt, Home address: 395 portsaid street, Bab el-kalq, Cairo, Egypt (Postal code: 11638), Mobile: +20 1066 7918 25Institution: Kasr Al-Ainy Faculty of Medicine, Cairo UniversityCairo - Egypt, Home address: 395 portsaid streetBab el-kalq, CairoPostal code: 11638Egypt

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Abstract

Objective

We aimed to perform a systematic review and meta-analysis in order to evaluate the effect of paracervical anesthetic block among women undergoing laparoscopic hysterectomy.

Methods

A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during January 2021. We selected randomized clinical trials (RCTs) compared paracervical anesthetic block versus normal saline (control group) among women undergoing laparoscopic hysterectomy. We pooled the continuous data as mean difference (MD) and dichotomous data as risk ratio (RR) with the corresponding 95% confidence intervals using Revman software. Our primary outcome was pain scores evaluated by visual analog scale (VAS) at 30 minutes and 1 hour. Our secondary outcomes were postoperative additional opioids requirement and length of hospital stay.

Results

Three RCTs met our inclusion criteria with a total number of 233 patients. We found that paracervical anesthetic block was linked to a significant reduction in VAS pain score at 30 minutes and 1 hour post-hysterectomy (MD= -2.13, 95% CI [-3.09, -1.16], p>0.001 & MD= -1.87, 95% CI [-3.22, -0.52], p=0.006). There was a significant decrease in additional opioids requirement postoperatively among paracervical anesthetic block group in comparison with control group (p=0.002). No significant difference was found between both groups regarding the length of hospital stay.

Conclusion

Paracervical anesthetic block is effective in reducing postoperative pain after laparoscopic hysterectomy with decrease in opioids administration postoperatively.

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Keywords : Hysterectomy, Laparoscopy, Pain, Paracervical block