Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial

Xu, Jian; Zhou, Riyong; Su, Weijue; Wang, Shi; Xia, Yun; Papadimos, Thomas J; Zhao, Junzhao; Xu, Xuzhong

doi:10.1136/bmjopen-2019-035887

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…e incidence of complications in the experimental group was significantly lower than that in the control group, but the maternal satisfaction was much higher than that in the control group (P < 0.05). Studies pointed out that pudendal nerve block may cause pelvic muscle relaxation, accelerate the progress of the second stage of labor, and shorten the time of the second stage of labor [18]. However, Kwon et al [19] mentioned in the article that the time of the second stage of labor was related to many factors, such as maternal age, fetal position, and baby weight.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Zhang

Xiao-ying

Zhao

et al. 2021

Scientific Programming

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This work was aimed to study the analgesic effect of pudendal nerve block on obstetrics and gynecology under the guidance of ultrasound image based on optimized fast super resolution reconstructed convolutional neural network (FSRCNN) algorithm. A total of 110 primiparas from hospital who gave birth through vagina were randomly rolled into experimental group (55 cases) and control group (55 cases). The optimized FSRCNN algorithm was constructed, compared with the FSRCNN algorithm and the Bicubic algorithm and applied to 110 cases of maternal patients undergoing perineotomy under ultrasound image-guided pudendal nerve block. Visual analogue scoring (VAS), incision suture pain VAS score, occurrence of complications, puerpera labor time, and newborn weight were recorded and compared, so did Apgar score of newborns, numbness of maternal thigh, recovery of puncture site, and satisfaction of maternal analgesia. The results showed that the peak signal-to-noise ratio (PSNR) of the high-resolution image reconstructed by the FSRCNN algorithm was 32.68 dB and that reconstructed by the optimized FSRCNN algorithm was 32.19 dB. The PSNR of the Bicubic algorithm processed image was 28.51 dB. In the lateral resection of episiotomy in the second stage of labor, the visual analog score (2.3 ± 1.5 points) of the experimental group was inferior to that of the control group (7.1 ± 2.6 points) ( P < 0.05 ). The visual analogue score of stitch pain (1.3 ± 0.8 points) was also inferior to that of the control group (5.2 ± 1.9 points) ( P < 0.05 ). Moreover, the satisfaction of the parturients in the experimental group (9.86 ± 0.41 points) was considerably superior to that of the control group (7.36 ± 1.25 points) ( P < 0.05 ). In short, the optimized FSRCNN algorithm had a short training time and good reconstruction effect. Ultrasound-guided pudendal nerve block had a substantial analgesic effect on the second stage of labor and improved parturients’ satisfaction.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Zhang

Xiao-ying

Zhao

et al. 2021

Scientific Programming

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“…A successful pudendal nerve block is crucial for the diagnosis of pudendal neuralgia and provides guidance for treatment. Different studies, including two randomized controlled trials, demonstrated the absence of complications for this procedure [ 5 , 16 – 21 ]. Furthermore, no significant difference in terms of efficacy was demonstrated between US and fluoroscopic guidance.…”

Section: Resultsmentioning

confidence: 99%

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VII, nerves of the lower limb

et al. 2021

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Objectives To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton’s neuroma) and provide clinical indications. Methods We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton’s neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. Results Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. Conclusion Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. Key Points • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

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“…One older randomized study suggested that spinal analgesia was superior to PNB for operative vaginal delivery 9 . In contrast, a recent randomized study suggests that ultrasound-guided bilateral PNB may serve as an additional, effective adjunct method of labor analagia 8 . The Cochrane review on analgesia for forceps delivery concluded that there is insufficient evidence to support any particular analgesic agent or method as the most effective in providing pain relief for forceps delivery 10 .…”

Section: Introductionmentioning

confidence: 92%

“…The use of PNB decreased as epidural and spinal analgesia became readily available 3 . The evidence is contradictory on the value or necessity of PNB in addition to epidural or spinal analgesia 8 - 10 . One older randomized study suggested that spinal analgesia was superior to PNB for operative vaginal delivery 9 .…”

Section: Introductionmentioning

confidence: 99%

Use of pudendal nerve block among midwives in Norway: A national cross-sectional study

Lukasse¹,

Bratsberg²,

Thomassen³

et al. 2022

Eur J Midwifery

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INTRODUCTION Pudendal nerve block (PNB) is an effective analgesic during the second stage of labor and for suturing. With the introduction of epidural and spinal analgesia, PNB use decreased considerably. Most midwives receive some teaching on PNB during their midwifery education. The aim of this study was to examine the use of PNB by midwives in Norway. METHODS This was a cross-sectional study, in January 2020, using an electronic questionnaire which was distributed to approximately 1500 midwives. RESULTS A total of 527 midwives responded to the questionnaire (35%). Less than half (44.6%) of the midwives used PNB, of whom only half (123/235) used it frequently (at least once a month). The use of PNB was most common at specialized obstetric units with ≥1500 births per year. Midwives who reported good theoretical knowledge and practical skills of PNB used it significantly more often than midwives not reporting these (p<0.001). Reasons for not using PNB were: the lack of practice and experience (72.6%), and never having been taught (42.8%). Midwives reported needing training (83%) and clinical support to start using PNB (43%). CONCLUSIONS Few midwives use PNB regularly. To increase the use of PNB, midwifery education needs to include both theoretical and practical skills teaching. Midwives with insufficient knowledge and skills require the same teaching and training. In the clinical area, midwives require clinical support and supervision to practice and gain experience. Women are not offered PNB as long as midwives are not confident in providing this method of pain relief.

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Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial

Cited by 9 publications

References 24 publications

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VII, nerves of the lower limb

Use of pudendal nerve block among midwives in Norway: A national cross-sectional study

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