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

Abstract

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.

Preparation and In Vivo Evaluation of a Lidocaine Self-Nanoemulsifying Ointment with Glycerol Monostearate for Local Delivery

“…Hemorrhoid disease is the third leading outpatient gastrointestinal diagnosis, accounting for 3.3 million office and emergency department visits in the United States [ 1 ]. The self-reported incidence of hemorrhoids in the United States is 10 million per year, corresponding to 4.4% of the population [ 2 , 3 , 4 ]. In addition, although rarely serious, hemorrhoids often have a significantly negative impact on the quality of life [ 5 ].…”

Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial

“…[3][4][5][6][7] Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy. [8][9][10] In our previous article, 11 we already described results of a double-blind randomized trial addressing the use of PNB in patients undergoing open hemorrhoidectomy. In short, we demonstrated that patients undergoing PNB in addition to spinal anesthesia had significantly less pain and shorter length of hospital stay after open hemorrhoidectomy.…”

“…As shorter hospital stay and unplanned re-admissions have been demonstrated already, 10,11 we can assume that the PNB use may also play a role in reducing costs related to hemorrhoid surgery but, to date, no study has addressed this aspect.…”

Nerve stimulator guided block for anorectal surgery – a video vignette

“…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].…”

“…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].…”