Ultrasound-guided stellate ganglion block attenuates early postoperative visceral pain after laparoscopic hysterectomy: A prospective randomized controlled trial

1. Ultrasound-guided stellate ganglion block significantly reduces early postoperative visceral pain after laparoscopic hysterectomy.

2. Stellate ganglion block provides an opioid-sparing effect without increasing clinically significant complications.

Evidence Rating Level: 1 (Excellent) 

Postoperative visceral pain remains a major contributor to morbidity after laparoscopic hysterectomy and is often inadequately controlled with standard regional techniques such as the transversus abdominis plane block, which primarily addresses incisional pain. This prospective, single-center randomized controlled trial evaluated whether ultrasound-guided stellate ganglion block could reduce early postoperative visceral pain and opioid requirements. Ninety patients undergoing laparoscopic hysterectomy were randomized to receive stellate ganglion block plus transversus abdominis plane block, transversus abdominis plane block alone, or no nerve block. Visceral and incisional pain were assessed using visual analogue scale scores at rest and with movement at 1, 3, 6, 24, and 48 hours postoperatively, and rescue opioid use and complications were recorded. Patients receiving stellate ganglion block had significantly lower visceral pain scores at rest and with movement at 1, 3, and 6 hours compared with both comparator groups, with no differences observed at later time points. The proportion of patients requiring rescue analgesia and total opioid consumption was also significantly reduced in the stellate ganglion block group. There were no significant differences in incisional pain, postoperative nausea and vomiting, gastrointestinal recovery, or length of stay. Minor transient Horner syndrome occurred in a small number of patients and resolved spontaneously. The authors conclude that ultrasound-guided stellate ganglion block effectively attenuates early postoperative visceral pain and reduces opioid demand after laparoscopic hysterectomy, supporting its role as an adjunct in multimodal analgesia protocols.

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