Aim: to assess an impact of laparoscopic superior hypogastric plexus (SHP) block combined with preemptive troacar site infiltration on postoperative pain intensity following laparoscopic myomectomy. Materials and Methods . The prospective randomized placebo-controlled double-blind clinical trial enrolled 207 patients undergoing laparoscopic myomectomy. Patients randomized into 3 groups with a target ratio of 1:1:1 were included in the study gradually, some (n = 9) were excluded from the study intraoperatively. Thus, the study included 198 patients: group 1 (n = 66) received standard systemic analgesia combined with troacar site infiltration and laparoscopic SHP block; group 2 (n = 65) received troacar site infiltration without SHP block; control group (group 3, n = 67) received standard systemic analgesia alone. The primary endpoint was presented by assessing pain intensity using the numeric rating scale (NRS) at 4 hours postoperatively. Secondary endpoints included NRS dynamics at 2, 6, 8, 12, and 24 hours postoperatively, time to first mobilization, opioid use, and pain quality assessment. Results . Pain scores were significantly lower in the combined analgesia group (group 1) at all time points assessed up to 12 hours postoperatively and at discharge (p < 0.05). Opioid use in group 1 was also markedly reduced (4.5 %) compared to control group 3 (32.8 %; p = 0.001). Time to first mobilization was significantly shorter in group 1 compared to group 2 and group 3 (median 5 hours vs. 7 hours; p = 0.017). Deep pelvic (visceral) pain was more commonly reported in group 2 and group 3 than in group 1 (p = 0.021). Conclusion . Preemptive multimodal analgesia combining troacar site infiltration with laparoscopic SHP block provides effective postoperative pain control, reduces opioid intake, and accelerates postoperative mobilization following laparoscopic myomectomy. This approach offers a promising strategy for improving recovery and minimizing opioid use in fertility-preserving gynecologic surgery.