The Effect of Pre-Sacral Nerve Block on Post-Operative Pain Following Laparoscopic Hysterectomy

Background & Objective: Total Laparoscopic Hysterectomy (TLH) is a preferred minimally invasive surgery in gynecology, yet postoperative pain management remains challenging. Despite reduced infection rates and shorter hospital stays, opioid use has not declined proportionally. Effective pain control is essential for recovery and patient satisfaction. The present study was conducted with aim to evaluate the efficacy of pre-sacral nerve block using bupivacaine in reducing postoperative pain following TLH.Materials & Methods: This triple-blind randomized controlled trial was conducted on 44 women at Ain Shams University Maternity Hospital. Participants were randomized into two groups: Group A (placebo; normal saline) and Group B (intervention; bupivacaine) injected into the uterosacral ligaments at the end of TLH. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at multiple time points up to two weeks. Secondary outcomes included narcotic and anti-emetic consumption, time to mobilization, and patient satisfaction. Version 23.0 of IBM©, SPSS© Statistics was used for data analysis. P<0.05 was considered significant.Results: Group B reported significantly lower VAS scores from 30 minutes to 24 hours postoperatively (P<0.001), and continued improvement up to two weeks. Pain reduction was consistently greater in the bupivacaine group. Patient satisfaction was significantly higher in Group B (P=0.022). No adverse events or delays in mobilization were noted.Conclusion: Pre-sacral nerve block with bupivacaine significantly reduces postoperative pain and improves patient satisfaction in TLH, supporting its integration into routine analgesia protocols.