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

Abstract

Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan–Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan–Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h ( p < 0.001 ) and during mobilization at 12, 24, 36, and 48 h ( p < 0.001 ) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0–24 h ( p < 0.001 ) and during 24–48 h ( p < 0.001 ) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p = 0.034 ). The patients in Group PNB had higher satisfaction compared to Group SA ( p < 0.001 ). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan–Morgan hemorrhoidectomy.

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate

“…A large body of evidence supports that intrapartum fever after intraspinal nerve block anesthesia is a noninfectious inflammation [ 13 ]. He et al [ 14 ] noted that the emergence of maternal fever after the administration of intraspinal nerve block anesthesia was mainly seen at 3–5 h after analgesia, where the dose of anesthetic drugs contributes most to the maternal temperature changes. In addition, the prolongation of the maternal survival process is also considered an independent influencing factor of intrapartum fever.…”

Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study

“…US guidance of the block has significantly reduced this risk. The risk of local anesthetic toxicity was also reduced by monitoring the distribution of local anesthetics [26]. The use of US guidance with NS also reduces the complication of nerve injury by preventing intraneural injection [27].…”

Comparison of saddle block and pudendal nerve block by SEPTA technique for anorectal surgeries: A randomized control study

“…12 It has disadvantage of recumbency in bed for a longer duration of time which can cause urinary retention in patients given saddle block. 7,13 It also has additional side effects such as nausea, vomiting, and headache due to dural puncture.…”