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

Abstract

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.

Efficacy of Unilateral Ilioinguinal Transversus Abdominis Plane Block for Alleviation of Catheter-related Bladder Discomfort in Male Patients after Emergence from General Anesthesia: a Prospective, Randomized Controlled Trial

“…With the rapid advancement of nerve blocks in recent years, the dorsal penile nerve block and pudendal nerve block have been demonstrated to be effective in decreasing the incidence and severity of CRBD 7,8 .…”

“…Mechanistically, CRBD is mediated by M3 muscarinic receptor activation, which induces involuntary contractions of the bladder detrusor 8 . The bladder receives the pelvic nerves from the S2~S4 spinal nerves and the hypogastric nerves from T11~L1 and L2 spinal nerves; thus, blockage of these nerves would theoretically relieve CRBD.…”

Efficacy of Unilateral Ilioinguinal Transversus Abdominis Plane Block for Alleviation of Catheter-related Bladder Discomfort in Male Patients after Emergence from General Anesthesia: a Prospective, Randomized Controlled Trial

“…With the rapid advancement of nerve block in recent years, dorsal penile nerve block and pudendal nerve block have been demonstrated to be effective in decreasing the incidence and severity of CRBD 7,8 . Moreover, efficacy of the transversus abdominis plane (TAP) block has been proven in various types of abdominal surgery 9 but reports that investigate the effects of TAPB in CRBD are unavailable.…”

“…Upon analyzing ten randomized clinical trials, De Oliveira GS Jr found that TAPB can reduce pain after laparoscopic surgical procedures 20 . However, there is no evidence supporting the use of TAPB as a rescue technique for CRBD.Mechanically, CRBD is mediated by M3 muscarinic receptor activation, which induces involuntary contractions of the bladder detrusor8 . The bladder receives the pelvic nerves from S2~S4 spinal nerves and the hypogastric nerves from T11~L1 and L2 spinal nerves, thus, blockage of these nerves would theoretically relieve CRBD.…”

The Novel Method to Reduce Catheter-Related Bladder Discomfort after Transurethral Prostate Surgery

“…The 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 [1]. The indwelling urinary catheter after transurethral prostate surgeries (TPS), especially transurethral resection of prostate (TURP) and Holmium laser enucleation of prostate, frequently leads to CRBD in the immediate postoperative period.…”