Impact of Adjunctive Truncal Regional Analgesia on Postoperative Sleep Quality After Total Abdominal Hysterectomy: A Prospective Observational Study
Emine Yılmaz Güler, İlke Dolğun, Sevilay Yavuz Doğu, Simge Türk, Öznur ŞenAbstract
Background
Sleep disturbances following total abdominal hysterectomy (TAH) impair recovery and satisfaction. Whether regional blocks improve postoperative sleep quality remains unexplored in gynecological surgery.
Objectives
To evaluate the effect of adjunctive regional blocks on postoperative sleep quality in patients undergoing TAH under general anesthesia.
Methods
This prospective observational study (ClinicalTrials.gov: NCT07069322) enrolled 66 women (ASA I–II) undergoing elective TAH. After excluding six patients (two for delirium, four voluntary withdrawals), 60 were analyzed: General anesthesia alone (GA, n = 29) or with adjunctive regional block (GA+RB, n = 31). Primary outcome was Richards-Campbell Sleep Questionnaire (RCSQ) score. Secondary outcomes included Pittsburgh Sleep Quality Index (modified PSQI), Visual Analog Scale (VAS) pain scores at 1, 6, 12, and 24 hours, and satisfaction (5-point Likert).
Results
Groups were demographically comparable. GA+RB had significantly higher RCSQ scores (73.0 ± 11.1 vs. 47.9 ± 16.9; P < 0.001). Postoperative modified PSQI worsened in the GA group (9.0 ± 2.4 to 11.7 ± 2.2; P < 0.001) but remained stable in GA+RB (8.1 ± 2.4 to 7.2 ± 2.3; P = 0.232). VAS scores were lower in GA+RB at all time points (all P < 0.001). Satisfaction was higher in GA+RB (4.0 ± 1.0 vs. 2.2 ± 1.2; P < 0.001). Regression identified 12-hour VAS (β = 0.56, P < 0.001) as the strongest predictor of postoperative modified PSQI.
Conclusions
Adjunctive regional blocks were associated with improved postoperative sleep quality, reduced pain, and higher patient satisfaction following TAH. Pain at 12 hours is the strongest modifiable predictor of sleep disturbance, supporting regional analgesia integration into multimodal perioperative protocols.