The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review

Fadel, Michael G; Peltola, L.; Pellino, Gianluca; Frunza, Gabriela; Kontovounisios, Christos

doi:10.1080/08941939.2020.1786611

Cited by 6 publications

(7 citation statements)

References 33 publications

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“…Complications related to the PNB procedure such as intravenous injection of the anesthetic, permanent nerve lesions, hematoma, abscesses or phlegmons were never reported in our literature search, 14,40,44,50 although this may have been subject to reporting bias. Pudendal nerve block obviously requires adequate training and expertise.…”

Section: Discussionmentioning

confidence: 87%

“…20 Several randomized trials have been published on PNB, but, to date, only 1 systematic review with no meta-analysis has been published. 14…”

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confidence: 99%

“…A recent evidencebased review has concluded that pudendal nerve block (PNB) is effective in controlling postoperative pain after colorectal surgical procedures. 14 Likewise, PROSPECT recommendations stated that PNB was preferred over the simpler but apparently less effective perianal infiltration. 12,13 Indeed, perianal anesthesia can be effective up to 6 hours, [15][16][17][18] whereas PNB has been demonstrated to last longer.…”

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confidence: 99%

“…20 Several randomized trials have been published on PNB, but, to date, only 1 systematic review with no meta-analysis has been published. 14 The aim of this systematic review and meta-analysis was to investigate the effect of PNB use on postoperative outcomes in patients undergoing hemorrhoidectomy.…”

mentioning

confidence: 99%

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

Mongelli¹,

Treglia

Regina³

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting. OBJECTIVE: The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy. DATA SOURCES: PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020. STUDY SELECTION: Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected. INTERVENTIONS: Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed. MAIN OUTCOME MEASURES: Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model. RESULTS: The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292–0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, –0.935; 95% CI, –1.280 to –0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, –1.862; 95% CI, –2.495 to –1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, –0.742; 95% CI, –1.145 to –0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062–0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged “high.” LIMITATIONS: Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study. CONCLUSIONS: This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.

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Section: Discussionmentioning

confidence: 87%

“…20 Several randomized trials have been published on PNB, but, to date, only 1 systematic review with no meta-analysis has been published. 14…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Mongelli¹,

Treglia

Regina³

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…Some self-limiting complications, including urine retention, mild bleeding, fever, tachycardia, or hypotension, usually heal on their own. Notably, hematoma, pudendal nerve injury, vascular injury, rectal perforation, muscular weakness or numbness in the region of nerve block, and urine or fecal incontinence are all unusual complications of PNB (26,27). Once those issues occur, pharmacological or even surgical intervention may be warranted.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of peripheral nerve block on postoperative catheter-related bladder discomfort in males: A systematic review and meta-analysis

Bao

Liu²,

Li³

et al. 2023

Front. Surg.

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ObjectiveTo determine the efficacy of peripheral nerve block (PNB) in preventing postoperative catheter-related bladder discomfort (CRBD).MethodsUp to July 1, 2022, the PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched, and all articles that met the PICOS (Patient, Intervention, Comparator, Outcome, Study design) criteria were enrolled. The included trials were evaluated using the Cochrane Collaboration's tool. Patients in the block group received bilateral PNB, while those in the non-block group did not need any additional procedure or simply achieved “sham block”. CRBD was quantified using the visual analog scale (VAS) score, which was questioned and recorded at 0–1 h, 1–2 h, 4–8 h, 8–12 h and 12–24 h intervals. The incidences of CRBD, moderate to severe CRBD and postoperative nausea and vomiting (PONV) were meta-analysed.ResultsSix trials with a total of 544 patients were considered. First, the block group had a lower incidence of CRBD than the non-block group at 0–1 h (OR 0.22; 95% CI, 0.18–0.08; P < 0.0001), 1–2 h (OR 0.14; 95% CI, 0.08–0.26; P < 0.00001), 4–8 h (OR 0.27; 95% CI, 0.13 to 0.58; P < 0.0008) and 8–12 h (OR 0.51; 95% CI, 0.30 to 0.87; P = 0.01). Second, the block group showed a lower incidence of moderate to severe CRBD than the non-block group at 0–1 h, 1–2 h and 4–8 h, and the ORs were 0.12 (95% CI, 0.03 to 0.49; P = 0.003), 0.17 (95% CI, 0.08 to 0.37; P < 0.00001) and 0.29 (95% CI, 0.15 to 0.55; P = 0.0002),respectively. Finally, the block group was significantly associated with a decreased incidence of PONV (OR, 0.14; 95% CI, 0.05 to 0.39; P = 0.0002).ConclusionThis meta-analysis suggested that PNB markedly reduced the incidence and severity of early postoperative CRBD and decreased the occurrence of PONV.

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Pudendal Nerve

Bellingham

Peng

2022

Regional Nerve Blocks in Anesthesia and Pain Therapy

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The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review

Cited by 6 publications

References 33 publications

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

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

The efficacy of peripheral nerve block on postoperative catheter-related bladder discomfort in males: A systematic review and meta-analysis

Pudendal Nerve

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