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

Abstract

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...

Ultrasound-Guided Pudendal Nerve Block Combined with Propofol Deep Sedation versus Spinal Anesthesia for Hemorrhoidectomy: A Prospective Randomized Study

“…Moreover, the mean time for first rescue analgesia was 14 hours in the PNB group, and it was 4 hours in the SA group. These results were similar to previous studies reporting that PNB had a longer analgesic effect than local infiltration [ 5 , 13 ]. In order to prolong the duration of PNB and provide better postoperative analgesia, dexmedetomidine was added as an adjuvant to the ropivacaine.…”

“…In theory, PNB enables analgesia or anesthesia of the perineal region. Previous studies reported that PNB can provide excellent postoperative analgesia for hemorrhoids surgery [5,9,[11][12][13][14]. e PNB was recommended for all patients undergoing hemorrhoidal surgery by PROSPECT (PROcedure-SPECific postoperative pain managemenT) Working Group [15].…”

Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis

“…Fourteen randomized trials with a total of 1214 patients were included in the present meta-analysis. 31–44…”

“…Inclusion criteria were well defined by all studies, whereas 4 did not specify the exclusion criteria. 32,33,39,40 Seven studies were double-blinded, 31,32,34,36,40,41,44 one was single-blinded 35 and the other did not qualify for either.…”

“…The PNB procedure was achieved in 4 studies under nerve stimulation 34–36,40 and in one 44 under ultrasound guidance; anatomic landmarks were used in the remaining 9 studies. 31–34,37–39,41–43 Ten studies reported a PNB, 33–40,42,44 whereas 4 used a different denomination to perform the pudendal nerve branches block (3 ischiorectal block 31,41,43 and 1 posterior perineal block 32 ). The type of anesthetics was highly variable: 8 studies used long-acting local anesthetics (bupivacaine or ropivacaine) at different volumes and concentrations, 32,33,37,38,40,41,43,44 5 used mixtures combining short- and long-acting local anesthetics, 31,34–36,42 and only 1 study used a short-acting anesthetic (lidocaine).…”