A Randomized Controlled Trial of Pudendal Nerve Block For Pain Relief after Episiotomy

Aissaoui, Y.; Bruyère, Rémi; Mustapha, Hassan; Bry, D.; Kamili, N. Drissi; Miller, C.

doi:10.1097/01.aoa.0000350642.26162.65

Cited by 8 publications

(11 citation statements)

References 2 publications

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“…Aissaoui et al [ 29 ] considers that pudendal nerve block is a simple and useful technology, and with the full implementation of 10 cases one can fully grasp the technology. In the present study, all the block operations were done by the same anesthesiologist using the nerve stimulation machine to ensure the homogeneity of the block effect.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

et al. 2017

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Background:Catheter-related bladder discomfort (CRBD) to an indwelling urinary catheter is defined as a painful urethral discomfort, resistant to conventional opioid therapy, decreasing the quality of postoperative recovery. According to anatomy, the branches of sacral somatic nerves form the afferent nerves of the urethra and bladder triangle, which deriving from the ventral rami of the second to fourth sacral spinal nerves, innervating the urethral muscles and sphincter of the perineum and pelvic floor; as well as providing sensation to the penis and clitoris in males and females, which including the urethra and bladder triangle. Based on this theoretical knowledge, we formed a hypothesis that CRBD could be prevented by pudendal nerve block.Objective:To evaluate if bilateral nerve stimulator-guided pudendal nerve block could relieve CRBD through urethra discomfort alleviation.Design and Setting:Single-center randomized parallel controlled, double blind trial conducted at West China Hospital, Sichuan University, China.Participants:One hundred and eighty 2 male adult patients under general anesthesia undergoing elective trans-urethral resection of prostate (TURP) or trans-urethral resection of bladder tumor (TURBT). Around 4 out of 182 were excluded, 178 patients were randomly allocated into pudendal and control groups, using computer-generated randomized numbers in a sealed envelope method. A total of 175 patients completed the study.Intervention:Pudendal group received general anesthesia along with nerve-stimulator-guided bilateral pudendal nerve block and control group received general anesthesia only.Main outcome measures:Incidence and severity of CRBD; and postoperative VAS score of pain.Results:CRBD incidences were significantly lower in pudendal group at 30 minutes (63% vs 82%, P = .004), 2 hours (64% vs 90%, P < .000), 8 hours (58% vs 79%, P = .003) and 12 hours (52% vs 69%, P = .028) also significantly lower incidence of moderate to severe CRBD in pudendal group at 30 minutes (29% vs 57%, P < .001), 2 hours (22% vs 55%, P < .000), 8 hours (8% vs 27%, P = .001) and 12 hours (6% vs 16%, P = .035) postoperatively. The postoperative pain score in pudendal group was lower at 30 minutes (P = .003), 2 hours (P < .001), 8 hours (P < .001), and 12 hours (P < .001), with lower heart rate and mean blood pressure. One patient complained about weakness in levator ani muscle.Conclusion:General anesthesia along with bilateral pudendal nerve block decreased the incidence and severity of CRBD for the first 12 hours postoperatively.

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Section: Discussionmentioning

confidence: 99%

Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

et al. 2017

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“…[27][28][29][30][31][32][33][34][35][36][37] . Six studies included patients undergoing abdominal hysterectomy, laparoscopy with perineal/vaginal procedures or obstetric surgery [27][28][29][30][31][32] ; 3 studies were trial registrations of full texts that were already included in the review [33][34][35] ; 2 studies used different interventions e.g. sacrocolpopexy [36,37] ; and 1 study assessed a different outcome -gluteal pain instead of perineal pain.…”

Section: Resultsmentioning

confidence: 99%

“…Pudendal nerve block in vaginal surgery has been used in a diversity of methods and clinical trials. [30][31][32][33] to decrease postoperative pain and use of postoperative opioids (Table 5a and 5b).…”

Section: Discussionmentioning

confidence: 99%

“…These results suggest that pre-emptive via PNB might be beneficial for the management of postoperative pain and for reducing analgesic requirement, but its clinical importance remains unclear. [18] Expected disadvantages of pudendal nerve block are incomplete analgesia, systemic toxicity and hematoma formation [3,4,17,18,32] However, these outcomes were not evaluated by studies included in this review and were under-powered to adequately assess these outcomes.…”

Section: Discussionmentioning

confidence: 99%

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The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

Rafique

Thompson

Al‐Jaroudi

et al. 2019

Preprint

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Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short- and intermediate-term outcomes of pre-emptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD: -0.89 (95% CI: -1.19, -0.59) and non-steroidal anti-inflammatories SMD -1.04 (95% CI: -1.64, -0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD: -0.82 (95% CI: -5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block. Key words:pre-emptive analgesia, bupivacaine, pudendal nerve block, vaginal surgery, pelvic organ prolapse, systematic review, meta-analysis

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“…In children, it is considered as an efficient alternative of caudal analgesia in hypospadias surgery with better postoperative pain management . The transperineal approach guided by nerve stimulator is considered as the reference in efficacy studies despite lack of data comparing the technique with or without use of nerve stimulator . Different types of motor responses are possible with nerve stimulation: rectal (anal sphincter contraction) or perineal (contraction of the transversalis perineum superficial muscle and movement of the penis/clitoris).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided pudendal nerve block in children: A new technique of ultrasound‐guided transperineal approach

Gaudet-Ferrand

Arena

Bringuier

et al. 2017

Pediatric Anesthesia

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Summary Background Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. Aims The first goal of this study was to describe this new technique and to test its feasibility. The second objective was to evaluate intra operative effectiveness and postoperative pain control. Methods After parental and children consent, this prospective descriptive study included children aged 1‐15 years, ASA status I‐III, scheduled for general anesthesia associated with bilateral pudendal nerve block for an elective perineal surgery. After standardized general anesthesia, the anesthesiologist performed pudendal nerve block under ultrasound guidance with “out of plane” approach and evaluated the visualization of anatomical structures (ischial tuberosity, rectum, and pudendal artery), of the needle and of the local anesthetic spread. Pudendal nerve block failure was defined as an increase in mean arterial blood pressure or heart rate more than 20% compared to baseline values after surgical incision. In the postoperative period, the need for rescue analgesia was noted. Results During the study period, 120 blocks were performed in 60 patients, including 59 boys. Quality of the ultrasonographic image was good in 81% of blocks, with easy visualization of ischium and rectum in more than 95% of cases. Localization of the tip of the needle was possible for all pudendal nerve blocks, directly or indirectly. The spread of local anesthetic was seen in 79% of cases. The block was effective in 88% of cases. Conclusion The new technique of ultrasound‐guided pudendal nerve block, described in this study, seems to be easy to perform with a good success rate, and probably improves safety of the puncture and of the injection by real‐time visualization of anatomical structures and local anesthetic spread.

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A Randomized Controlled Trial of Pudendal Nerve Block For Pain Relief after Episiotomy

Cited by 8 publications

References 2 publications

Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

Ultrasound‐guided pudendal nerve block in children: A new technique of ultrasound‐guided transperineal approach

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