Stellate Ganglion Block Reduces Postoperative Pain and Opioid Use After Laparoscopic Hysterectomy: Study
Researchers have found in a new study that Ultrasound-guided stellate ganglion block significantly decreases early postoperative visceral pain following laparoscopic hysterectomy. The intervention also demonstrates a clear opioid-sparing effect, reducing the need for postoperative opioids without increasing clinically significant complications, supporting its safety and analgesic benefit. The study was published in PLOS One journal by Jing Lin and fellow researchers.
Postoperative visceral pain is a significant problem, often poorly controlled, following laparoscopic hysterectomy, and contributes to increased opioid use in the early recovery period. New evidence now suggests that ultrasound-guided stellate ganglion block can effectively decrease early postoperative visceral pain and opioid requirements after gynecologic laparoscopy. Although TAPB is widely used for the control of somatic pain after abdominal surgery, its effect is limited regarding visceral pain. SGB, classically utilized in sympathetic-mediated pain, has been emerging as a potential tool in the modulation of visceral pain pathways.
A prospective, randomized controlled study was conducted among 90 patients undergoing laparoscopic hysterectomy. Patients were randomly assigned to one of three groups with a ratio of 1:1:1:
SGB group: Ultrasound-guided Stellate Ganglion Block + Transversus Abdominis Plane Block
TAP group: Transversus abdominis plane block only
Control Group: Without Nerve Block
Visceral pain intensity was assessed using scores on the visual analog scales (VAS) of rest and movement pain at 1, 3, and 6, and 24 and 48 hours postoperatively. The secondary outcomes included the proportion of patients needing rescue analgesia and the incidence of block-related complications.
Key findings
• The requirement of rescue analgesia varied considerably between the groups. The requirement of rescue analgesia in the SGB, TAP, and control groups was 14.3%, 32.1%, and 48.1%, respectively (P < 0.05).
• There were no differences in incisional pain scores in the SGB, TAP, and control groups at any time postoperatively (P > 0.05).
• In this randomized study of 90 patients, the use of SGB under ultrasound guidance relieved visceral pain scores of postoperative patients more effectively at 1, 3, and 6 hours postoperatively, in comparison to TAPB and the control group (P < 0.05).
• There were fewer requirements of rescue analgesia in the SGB group compared to the TAP and Control Groups (14.3% vs 32.1% and 48.1%, respectively).
• There were no differences in incisional pain and major complications.
The study concluded that SGB, performed using ultrasound guidance, distinctly relieved the viscerally mediated early postoperative pain and diminished opioid requirements in the early postoperative period after laparoscopic hysterectomy. Adding SGB to current analgesia practices makes SGB a beneficial and safe modality in multimodal strategies for the optimization of early postoperative recovery.
Reference:
Lin J, Huang Y, Wen Y, Yang W, Zuo Y (2025) Ultrasound-guided stellate ganglion block attenuates early postoperative visceral pain after laparoscopic hysterectomy: A prospective randomized controlled trial. PLoS One 20(12): e0339677. https://doi.org/10.1371/journal.pone.0339677
