Nerve‐stimulator‐guided pudendal nerve block by pararectal approach

Kim, S.-H.; Song, Seokhwan; Paek, O. J.; Lee, H. J.; Park, D. H.; Lee, J. K.

doi:10.1111/j.1463-1318.2011.02720.x

Cited by 23 publications

(10 citation statements)

References 17 publications

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“…Pudendal nerve block requires special skills but can be learned quickly. 21 The best way to apply a block is with the help of a nerve stimulator that will guide the appropriate depth and location so that the infiltration of the local anaesthetic achieves an optimal response, but we lack this capacity in our configuration.…”

Section: Discussionmentioning

confidence: 99%

Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial

Yasrab

Naqvi²,

Ahmed³

et al. 2022

PAFMJ

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Objective: To compare the frequency and severity of post-operative CRBD in patients undergoing TURP and TURBT with spinal anaesthesia with pudendal nerve block against spinal anaesthesia alone. Study Design: A randomized controlled trial (Clinical trials.gov: NCT05022160) Place and Duration of Study: Armed Forces Institute of Urology (AFIU), Rawalpindi Pakistan, from Aug to Nov, 2021. Methodology: The trial comprised 250 patients scheduled to have a transurethral resection of the prostate (TURP) or a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. They were split into two groups: study (group-P) and control (group-C). After surgery, the patients in the study-group were given a bilateral pudendal nerve block. At 3, 8, 12, and 24 hours following surgery, the frequency and severity of catheter-related bladder discomfort (CRBD) were documented. Results: CRBD frequencies were significantly lower in pudendal group at 3 hours 42 (33.8%) vs 72 (58.5%), p <0.001), 8 hours 81 (65.3%) vs 111 (90.2%), p<0.001 and 12 hours 53 (42.7%) vs 73 (59.3%), p=0.009 after the surgery. The postoperative pain score in pudendal group was lower at 3 hours (p<0.001), 8 hours (p <0.001), and 12 hours (p=0.02) but there was no statistically significant difference between the two groups at 24 hours (p=0.06). Conclusion: When used in conjunction with spinal anaesthesia, a pudendal nerve block reduces the frequency and severity of catheter-related bladder discomfort for up to 12 hours after surgery.

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Section: Discussionmentioning

confidence: 99%

Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial

Yasrab

Naqvi²,

Ahmed³

et al. 2022

PAFMJ

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“…The analgesic efficacy of the PNB during anorectal and urologic procedures arises from blocking the inferior rectal nerve, which supplies perianal skin, anoderm, and the external anal sphincter, and the perineal nerve, which has a superficial branch that supplies the labia or scrotum and a deep branch that supplies the external anal sphincter and urethral sphincter and mucosa [2,8]. Multiple approaches to the PNB have been described, including transvaginal, transperineal, transgluteal, and transrectal routes [1]. In female patients, the ischial spine is easily palpated transvaginally with the patient in lithotomy position, and anesthetic is typically injected posteriorly to the ischial spine at the attachment of the sacrospinous ligament, often without the use of image guidance [9].…”

Section: Discussionmentioning

confidence: 99%

“…This nerve block is more technically challenging in men, requiring an alternative approach such as transrectal, transperineal, transgluteal techniques, which many physicians are less comfortable and less experienced with performing. This procedure typically requires mul-DOI: http://dx.doi.org/10.21454/rjaic.7518.242.klv tiple injections, a potentially increased amount of time depending on the procedura list, and special equipment including C-arm fluoroscopy, nerve stimulators, and ultrasonography [1]. This complexity often leads to the underuse of the PNB in men.…”

Section: Introductionmentioning

confidence: 99%

Pudendal nerve blocks in men undergoing urethroplasty: a case series

2017

Rom J Anaesth Intensive Care

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The pudendal nerve block (PNB) is widely used for regional anesthesia during obstetric and anorectal procedures, but its role in urologic procedures has not been thoroughly studied. While transvaginal PNB is relatively straightforward, PNB in male patients often requires imaging guidance due to difficulty appreciating anatomic landmarks. We review the PNB and relevant sonoanatomy, and describe its analgesic efficacy in three male patients undergoing urethroplasty for urethral stricture. In this procedure, the patient was placed in lithotomy position, the ischial tuberosity was palpated, and the sacrotuberous ligament and pudendal artery were identified using ultrasound. Ropivacaine was injected medial to the pudendal artery and disappearance of muscle twitch was demonstrated. Two patients reported well-controlled pain at 24 hours postoperatively. One reported perineal pain requiring additional analgesia. All patients were discharged on postoperative day 1 without complications. Ultrasound-guided PNB provides safe and reasonably effective pain control to male patients undergoing urologic procedures.

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“…They include US, 6,15 computed tomography, 1,16-18 fluoroscopy, 4 and ENS. 19 Computed tomography guidance alone 1,18 or in combination with US (real-time image fusion) 20 has been used at the level of the Alcock canal. Ultrasound guidance has been used transperineally.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal

Bendtsen

Parras

Moriggl

et al. 2016

Regional Anesthesia and Pain Medicine

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Nerve‐stimulator‐guided pudendal nerve block by pararectal approach

Abstract: Nerve-stimulator-guided PNB using a pararectal approach proved to be easy and safe, with acceptable patient tolerance. In addition, it can be used for a variety of anorectal procedures where relaxation of anal tone is required.

Cited by 23 publications

References 17 publications

Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial

Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial

Pudendal nerve blocks in men undergoing urethroplasty: a case series

Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal

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