The Effect of Caudal Ropivacaine and Morphine on Postoperative Analgesia in Total Laparoscopic Hysterectomy: A Prospective, Double-Blind, Randomized Controlled Trial

Abstract

Purpose

Multiple regional nerve blocks proved no additional benefit in total laparoscopic hysterectomy in multimodal analgesia, as postoperative pain may mainly originate from the vaginal cuff. Theoretically, caudal block can relieve pain from the vaginal cuff by a sacral spinal nerve block. We aimed to verify whether a caudal block with ropivacaine and morphine can achieve an analgesic effect without additional adverse effects after a total laparoscopic hysterectomy.

Patients and Methods

Forty-eight patients undergoing total laparoscopic hysterectomy were randomly allocated to receive preoperative caudal block with 20 mL of mixture including 0.25% ropivacaine and 2 mg morphine (caudal block group) or sham block (sham group). The primary outcome was the postoperative 24 h cumulative sufentanil consumption.

Results

Median (IQR) sufentanil consumption in the first 24 postoperative hours of the caudal block group and the sham group was 0.00 (0.00 to 0.05) μg/kg vs 0.13 (0.04 to 0.21) μg/kg, respectively, p < 0.001. The majority of patients felt that visceral pain was more intense than incisional pain at 1, 6, 12, and 24 h post-surgery in the sham group (95.8% at 1 h, 95.8% at 6 h, 95.8% at 12 h, and 75% at 24 h post-surgery). Compared to the sham group, the caudal block reduced visceral pain scores at rest and during movement at 1 h (p < 0.001), 6 h (p < 0.001), 12 h (p < 0.001), and 24 h (p < 0.001) post-surgery. Intraoperative remifentanil consumption was significantly lower in the caudal block group than in the sham group (p = 0.004). There were no significant differences in other secondary outcomes between the two groups.

Conclusion

A caudal block with ropivacaine and morphine could provide a satisfactory analgesic effect for 24 h postoperatively without additional adverse effects after total laparoscopic hysterectomy.

Keywords:

• anesthesia
• caudal
• visceral pain
• hysterectomy
• pain
• postoperative
• postoperative nausea and vomiting
• gynecologic surgical procedures

Data Sharing Statement

The manuscript presents all the data that substantiate our conclusion. The individual deidentified participant data will be available from the corresponding author ([email protected]) for reasonable request.

Ethics Approval and Informed Consent

Informed consent was obtained from all the study patients and this study complies with the Declaration of Helsinki. The Scientific Research Ethics Committee of the Affiliated Hospital of Jiangsu University, China, approved this single-center, prospective, randomized controlled study (KY2022H1014-4).

Acknowledgments

We acknowledge the contributions of Dr Hanpeng Lai, Department of Occupational and Environmental Health, School of Public Health, Yangzhou University, Yangzhou, China, for the statistical analyses.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Postgraduate Research & Practice Innovation Program of Jiangsu Province (No. SJCX23_2100), the Medical Education Collaborative Innovation Fund of Jiangsu University (No. JDY2022006), and the Scientific Research Project of “Jinshan Talents” in Zhenjiang City (No. YLJ202109).