Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial

Imbelloni, Luiz Eduardo; Beato, Lúcia; Beato, Carolina; Cordeiro, José Antônio; Souza, Dulcimar Donizete de

doi:10.1590/s0034-70942005000600004

Cited by 19 publications

(10 citation statements)

References 7 publications

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“…In brachial plexus block, the enantiometric mixture (S75:R25) is a safer alternative if compared to racemic bupivacaine, due to its lower toxicity 7 . Based on a pilot study that reported reduction of postoperative pain with average analgesia of 24 hours 8 , this prospective, randomized, double-blind study was conducted to investigate the analgesia produced with bilateral pudendal blockade using levobupivacaine enantiomeric excess (S75:R25), compared to the method commonly used.…”

Section: Introductionmentioning

confidence: 99%

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

Imbelloni¹,

Vieira²,

Carneiro³

2012

J. Coloproctol. (Rio J.)

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Imbelloni LE; Vieira EM; Carneiro AF. Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study. J Coloproctol, 2012;32(3): 291-296. ABSTRACT: Background and objectives:Reducing postoperative pain in hemorrhoidectomy is still a challenge. This prospective, randomized, double-blind study was conducted to compare bilateral pudendal blockade with peripheral nerve stimulator to relieve postoperative pain with the method commonly used. Method: 200 patients scheduled for hemorrhoidectomy were randomly divided into Control Group and Pudendal Group. Bilateral pudendal block was performed with levobupivacaine enantiomeric excess (S75:R25) after location with a peripheral nerve stimulator. The parameters evaluated were pain intensity, duration of analgesia, rescue analgesia, complications, patient satisfaction and pain at first defecation. Data were recorded at 6, 12, 18 and 24 hours after the surgery. Results: Bilateral pudendal nerves with mean 23.4±4.4 hours provided better relief of postoperative pain (p<0.001), reducing the need for analgesics and residual analgesia for more than 24 hours in 41% of patients. All patients in Pudental Group had spontaneous micturition versus 96 in the control group. There was no local or systemic complications. Conclusions: Bilateral blockade of the pudendal nerve using a neurostimulator provided better pain relief with less need for rescue dose and no local or systemic complications.Keywords: colorectal surgery; ambulatory surgical procedures; anesthetic, local; pudendal nerve. RESUMO: Justificativa e objetivos:A dor pós-operatória em hemorroidectomia ainda é um problema desafiador. Este estudo prospectivo, aleatório, duplamente encoberto, foi realizado para comparar o bloqueio bilateral do pudendo com estimulador de nervos periféricos para alí-vio da dor pós-operatória ao método habitualmente utilizado. Método: 200 pacientes escalados para hemorroidectomia foram aleatoriamente separados em Grupo Controle e Grupo Pudendo. O bloqueio bilateral do Grupo Pudendo foi realizado com levobupivacaína em excesso enantiomérico (S75:R25) após localização com estimulador de nervo periférico. Os parâmetros avaliados foram: intensidade da dor, duração da analgesia, resgate de analgésico, complicações, satisfação dos pacientes e dor à primeira defecação. Os dados foram anotados as 6, 12, 18 e 24 horas após a cirurgia. Resultados: O bloqueio bilateral dos pudendos, com média de 23,4±4,4 horas proporcionou um melhor alívio da dor pós-operatória (p<0,001), reduzindo a necessidade de analgésicos e com analgesia residual maior de 24 horas em 41% dos pacientes. Todos do Grupo Pudendo tiveram micção espontânea contra 96 do Grupo Controle. Não se observaram complicações locais ou sistêmicas. Conclusões: O bloqueio bilateral dos nervos pudendos com neuroestimulador proporcionou melhor alívio da dor, com menor necessidade de dose de resgate e sem complicações locais ou sistêmicas.Palavras-chave: cirurgia colorretal; procedimentos cirúrg...

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Section: Introductionmentioning

confidence: 99%

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

Imbelloni¹,

Vieira²,

Carneiro³

2012

J. Coloproctol. (Rio J.)

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“…There was no statistical difference between the groups in this respect. Complications such headache (4) and bladder function disorders (6) have been described in relation to SA, but no such complications have been reported with LA. Complications relating to colon reconstruction, such as prolonged ileus and dehiscence of anastomosis have been described in other studies (2) .…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

Abreu¹,

Vaz

Laurino

et al. 2010

Arq. Gastroenterol.

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-Context -Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. Objectives -Randomized clinical trial to compare the results from these two techniques. Methods -Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25). Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin). Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. Results -Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. Conclusions -Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure. HEADINGS -Anesthesia, spinal. Anesthesia, local. Colostomy.There were no conflicts of interest in the present research.

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“…A anestesia dos nervos pudendos é uma boa técnica nas cirurgias anorretais, cirurgias perineais e analgesia de parto 8,9 . Imbelloni e col. 10 avaliaram a analgesia com bloqueio dos nervos pudendos em pacientes submetidos a hemorroidectomia sob raquianestesia, utilizando estimulador de nervos pela técnica transperineal. No estudo, 51% dos pacientes não necessitou de nenhum analgésico no pós-operatório e 77% deles consideraram a técnica excelente.…”

Section: Discussionunclassified

“…The anesthesia of the pudend nerves is a good technique in the anorectal surgeries, in the perineal surgeries and labor analgesia 8,9 . Imbelloni et al 10 evaluated the analgesia with the blockade of the pudend nerves in patients submitted to hemorrhoidectomy under spinal anesthesia, using a nerve stimulator through the transperineal technique. In the study, 51% of the patients did not need any postoperative analgesic and 77% of the patients considered it an excellent technique.…”

Section: Discussionmentioning

confidence: 99%

Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso

Morais¹,

Cruvinel²,

Silva³

et al. 2006

Rev. Bras. Anestesiol.

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Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial

Cited by 19 publications

References 7 publications

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: a controlled clinical study

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso

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