685: Paracervical block for postoperative pain following laparoscopic gynaecological surgeries

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Acute postsurgical pain, Developing methodology/technology, Pharmacological treatments, Assessment and Measurement of Pain/Nociception

Background and Aims: Postoperative pain following laparoscopic surgery remains clinically significant despite its minimally invasive nature. Regional analgesia can reduce perioperative opioid use. However, its routine use in laparoscopic gynaecological surgeries (LGS) remains unclear. Paracervical block (PCB) is a simple regional analgesia technique. It acts by blocking uterovaginal visceral afferent pathways. But its adoption remains limited in routine LGS, particularly in low-resource, high-volume centres. Data on its effect on postoperative pain trajectories and opioid consumption are scarce. This study evaluated the impact of lignocaine-based PCB on postoperative pain and related outcomes following LGS.

Methods: This prospective, non-randomized cohort study was conducted at a tertiary care centre in Sri Lanka. It included women undergoing LGS for benign indications. Participants received either PCB or conventional opioid-based analgesia. The block was given under general anaesthesia. Ten millilitres of 2% lignocaine (maximum dose 7 mg/kg) was diluted up to 20ml in 0.9% sodium chloride. Injections were made at the 2 and 5 o’clock positions bilaterally, and the 6 o’ clock position of the cervicovaginal junction. Postoperative pain including backache was assessed using a visual analogue scale at predefined time points.

Results: The study included 162 women. Fifty-four received PCB and 108 received opioid-based analgesia. Postoperative pain scores were significantly lower in PCB group at all measured intervals (all p<0.028). Opioid consumption was markedly lower; morphine (1.19 vs 10.46 mg), tramadol (0 vs 14.8 mg), and fentanyl (0 vs 5.5 mcg) (all p< 0.012). New onset postoperative backache was more frequent (27.8% vs 16.6%, p=0.05) and more severe (p=0.012) among PCB recipients. Hospital stay was significantly shorter in the PCB group (11.2 vs 14.8 hours, p<0.001).

Conclusions: PCB with lignocaine provides effective postoperative analgesia and substantial opioid-sparing benefit following LGS. While it does not improve postoperative backache, its overall pain modifying impact is clinically meaningful. PCB represents a low-cost and easily implementable analgesic adjunct. This is particularly important in resource-limited settings. Further studies should refine technique and dosing. Careful patient selection may improve analgesic benefit while mitigating adverse effects.

References: 1. Noor N, Roy KK, Zangmo R, et al. Role of para-cervical block in reducing immediate postoperative pain after total laparoscopic hysterectomy: a prospective randomized placebo-controlled trial. Obstetrics & Gynecology Science. 2021 Jan 12;64(1):122-9.

Presenting Author: Ashani Ratnayake
Submitting Author: Ashani Ratnayake

Senior Author: Ashani Ratnayake

IASP 2026 Global Year theme of Neuropathic Pain: No

• Sampath Gnanarathne: MBBS/ MD/ MRCOG - Faculty of Medicine, University of Peradeniya, Sri Lanka
• Ashini Uhanovita: MBBS - Faculty of Medicine, University of Peradeniya, Sri Lanka