Pudendal nerve block: a safe, simple and effective approach in surgical proctological patients

Bonatti, Luca; Soncini, Stefania; Bellocchia, Alex B.; Селиванов, Д. Д.; Cestino, Luca; Festa, Federico; Natta, F; Quaglino, Francesco

doi:10.23736/s2724-5691.21.08810-9

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Rectovaginal fistula (RVF) can occur as a postoperative complication, typically following sphincter-preserving rectal resection [1]. Although some studies have reported colostomy, fistulectomy, suture closure, pull-through and redo anastomosis for treatment in such cases, the optimal strategy remains controversial due to high failure rates [2][3][4][5].…”

Section: S U Pp O Rti N G I N Fo R M Ati O Nmentioning

confidence: 99%

“…Optimal pain control, especially in a surgical day care setting, provides enhanced recovery and patient satisfaction. Anal and pudendal nerve blocks have been reported to reduce acute postoperative pain in perineal surgery [1–3]. Several techniques such as ultrasound and specialized equipment have been used to determine the correct position of the needle [4].…”

mentioning

confidence: 99%

“…June 2022 | Revised: 24 July 2022 | Accepted: 12 August 2022 DOI: 10.1111/codi.16309Nerve stimulator guided block for anorectal surgery -a video vignetteDear Editor, Optimal pain control, especially in a surgical day care setting, provides enhanced recovery and patient satisfaction. Anal and pudendal nerve blocks have been reported to reduce acute postoperative pain in perineal surgery[1][2][3]. Several techniques such as ultrasound and specialized equipment have been used to determine the correct position of the needle[4].…”

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confidence: 99%

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Nerve stimulator guided block for anorectal surgery – a video vignette

et al. 2022

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Section: S U Pp O Rti N G I N Fo R M Ati O Nmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Nerve stimulator guided block for anorectal surgery – a video vignette

et al. 2022

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“…The pudendal nerve is comprised of both sensory and motor nerves from the sacral plexus, originating from the S2-S4 spinal nerve roots. The pudendal nerve emits branches within the pudendal canal, which innervate the sensation and movement of the clitoris, penis, and perineum ( Alkhaldi et al, 2015 ; Bonatti et al, 2022 ). Previous studies have shown that pudendal nerve block for postoperative analgesia provides a longer-lasting effect compared to epidural anesthesia, with a lower incidence of postoperative urinary retention and a higher benefit-to-risk ratio ( Dadure et al, 2009 ; Ecoffey et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of combined administration of ropivacaine and dexamethasone on postoperative analgesia in perianal surgery with pudendal nerve block under ultrasound guidance: a prospective randomized controlled study

Yang,

Pu,

Cheng

et al. 2024

Front. Pharmacol.

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BackgroundIn recent years, severe pain after perianal surgery has seriously affected the prognosis of hospitalized patients. How to maximize the improvement of postoperative pain and perioperative comfort becomes particularly important.MethodsThis study was a double-blind randomized controlled trial (Registration No.: ChiCTR2100048760, Registration Date: 16 July 2021, Link: www.chictr.org.cn/showproj.html?proj=130226), and patients were randomly divided into two groups: one group underwent postoperative 20 mL bilateral pudendal nerve block with 0.5% ropivacaine (P group), and the other group underwent postoperative 20 mL bilateral pudendal nerve block with 0.5% ropivacaine + 8 mg dexamethasone (PD group). The primary outcome was the incidence of moderate to severe pain at the first postoperative dressing change. Secondary outcomes included Quality of recovery-15 (QoR-15) score at 3 days after surgery, sleep quality, pain score at 3 days after surgery, and incidence of adverse events.ResultsIn the main outcome indicators, the incidence was 41.7% in the P group and 24.2% in the PD group (p = 0.01). The QoR-15 score and sleep quality in PD group were better than those in P group 2 days before surgery. The incidence of postoperative urinary retention was significantly decreased in PD group (p = 0.01).ConclusionLocal anesthesia with dexamethasone combined with pudendal nerve block after perianal surgery can reduce the incidence of moderate to severe pain during the first dressing change. This may be one of the approaches to multimodal analgesia after perianal surgery.Clinical Trial Registrationhttps://www.chictr.org.cn/, identifier ChiCTR2100048760.

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Does the addition of perineal block enhance pain control after a haemorrhoidectomy? A prospective randomized, double‐blind placebo‐controlled study

Markaryan,

Garmanova,

Kazachenko

et al. 2024

ANZ Journal of Surgery

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BackgroundHaemorrhoidectomy is associated with severe postoperative pain, a long rehabilitation, and QoL worsening for months. Most patients experience mild‐to‐moderate postoperative pain. We aimed to evaluate the intraoperative perineal block role for patients undergoing haemorrhoidectomy.MethodsIn this prospective randomized, double‐blind, placebo‐controlled study, eligible patients with III–IV stage haemorrhoids were randomized to the experimental group (EG) with intraoperative perineal block and spinal anaesthesia and the control one (CG) only with spinal anaesthesia. During the postoperative period, the opioid consumption rate was evaluated as a primary endpoint, and the postoperative pain level according to VAS, systemic analgesics consumption, readmission, and complication rate, the timing of returning to work, patients' QoL, and overall satisfaction according to SF‐36 were evaluated as secondary endpoints.ResultsOne hundred patients completed the study (48 in EG and 52 in CG). Patients of the EG had less postoperative pain intensity (P < 0.0001), required less opioid analgesia (P = 0.03), and had longer pain‐free postoperative periods (P = 0.0002). 90% of patients in the CG required additional NSAID injections for adequate analgesia compared with only 58% in the EG. The average hospital stays, complication rate, and average operation duration didn't reach clinical significance. General health evaluation according to the SF‐36 score and the median satisfaction rate was better in the EG (P < 0.001 and P = 0.012, respectively).ConclusionsThe administration of the perianal block is safe and effective and should be administered to appropriate patients undergoing anorectal surgery.

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Pudendal nerve block: a safe, simple and effective approach in surgical proctological patients

Cited by 5 publications

References 17 publications

Nerve stimulator guided block for anorectal surgery – a video vignette

Nerve stimulator guided block for anorectal surgery – a video vignette

The impact of combined administration of ropivacaine and dexamethasone on postoperative analgesia in perianal surgery with pudendal nerve block under ultrasound guidance: a prospective randomized controlled study

Does the addition of perineal block enhance pain control after a haemorrhoidectomy? A prospective randomized, double‐blind placebo‐controlled study

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