The Effect of Pudendal Block on Voiding After Hemorrhoidectomy

Kim, Jae Hwang; Lee, Dongsik; Jang, Seon-Mo; Shim, Min-Chul; Jee, Dae Lim

doi:10.1007/s10350-004-0798-2

Cited by 58 publications

(70 citation statements)

References 15 publications

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“…For example, caudal and spinal anesthesia frequently cause urinary retention due to disruption of the micturition reflex. Kim et al 2005 showed a significantly lower rate of postoperative urinary retention in hemorrhoidectomy patients who received PNB instead of spinal anesthesia (7.5% compared with 69.6%), as well as a smaller required volume of analgesic and significantly longer and more effective postoperative pain control in the PNB cohort [2]. Similarly, Imbelloni et al 2007 demonstrated spontaneous micturition in 98 of 100 hemorrhoidectomy patients after PNB [3].…”

Section: Conflict Of Interestmentioning

confidence: 90%

“…The pudendal nerve exits through the greater sciatic foramina inferior to the piriformis muscle, crosses the posterior aspect of the sacrospinous ligament at the level of the ischial spine, and reenters the pelvis through the lesser sciatic foramina, then courses through Alcock's canal posteroinferiorly and divides into the inferior rectal nerve, perineal nerve, and the dorsal nerve of the clitoris or penis. The analgesic efficacy of the PNB during anorectal and urologic procedures arises from blocking the inferior rectal nerve, which supplies perianal skin, anoderm, and the external anal sphincter, and the perineal nerve, which has a superficial branch that supplies the labia or scrotum and a deep branch that supplies the external anal sphincter and urethral sphincter and mucosa [2,8]. Multiple approaches to the PNB have been described, including transvaginal, transperineal, transgluteal, and transrectal routes [1].…”

Section: Discussionmentioning

confidence: 99%

“…Pain associated with local injection can be mitigated with preoperative treatment with an analgesic such as fentanyl 50 mcg [2] or subcutaneous 2% lidocaine hydrochloride with adrenaline [15]. The risk of blindly injecting during PNB is mitigated by use of imageguided techniques such as ultrasonography.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…This complexity often leads to the underuse of the PNB in men. While the merits of PNB in anorectal procedures such as hemorrhoidectomy [2][3][4] and transrectal ultrasound (TRUS)-guided prostate biopsy [5] are well studied, its utility in urologic procedures has not been as well described. We report a series of three male patients who received ultrasound and nerve stimulator guided PNB for postoperative analgesia following urethroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Pudendal nerve blocks in men undergoing urethroplasty: a case series

2017

Rom J Anaesth Intensive Care

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The pudendal nerve block (PNB) is widely used for regional anesthesia during obstetric and anorectal procedures, but its role in urologic procedures has not been thoroughly studied. While transvaginal PNB is relatively straightforward, PNB in male patients often requires imaging guidance due to difficulty appreciating anatomic landmarks. We review the PNB and relevant sonoanatomy, and describe its analgesic efficacy in three male patients undergoing urethroplasty for urethral stricture. In this procedure, the patient was placed in lithotomy position, the ischial tuberosity was palpated, and the sacrotuberous ligament and pudendal artery were identified using ultrasound. Ropivacaine was injected medial to the pudendal artery and disappearance of muscle twitch was demonstrated. Two patients reported well-controlled pain at 24 hours postoperatively. One reported perineal pain requiring additional analgesia. All patients were discharged on postoperative day 1 without complications. Ultrasound-guided PNB provides safe and reasonably effective pain control to male patients undergoing urologic procedures.

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Section: Conflict Of Interestmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Conflict Of Interestmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pudendal nerve blocks in men undergoing urethroplasty: a case series

2017

Rom J Anaesth Intensive Care

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“…Despite penile anaesthesia following PNB, urinary retention and other annoying post-operative voiding complications are not common (17).…”

Section: Discussionmentioning

confidence: 99%

Pain Management Following Anorectal Surgery Using Patient- Controlled Analgesia vs. Pudendal Nerve Block: A Clinical Trial

Honar¹,

Mirkheshti²,

Mahdinezhad³

et al. 2017

Trauma Mon

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Background: The use of patient-controlled analgesia (PCA) has increased in recent years. Data regarding PCA's usefulness following anorectal surgery are equivocal, and it still needs to be further studied and discussed. Therefore, the current study was conducted to compare PCA with pudendal nerve block (PNB) for pain management in patients undergoing anorectal surgery. Methods: Patients candidate for elective anorectal surgery under general anaesthesia were considered eligible. Prior to the surgery, the patients were divided into PCA and PNB groups. PNB was performed at the end of the surgery just before extubation. PCA was initiated in the recovery room. The patients' pain scores were recorded based on an 11-point numerical rating scale (NRS) at 2, 6, 12, and 24 hours into the post-operative period. The total dose of morphine sulfate consumed, the overall satisfaction, and any side effects were recorded.

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Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

Rotigliano¹,

Füglistaler²,

Guenin³

et al. 2020

British Journal of Surgery

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Background The benefit of a perianal block as an adjunct to general or regional anaesthesia is debated. This RCT aimed to compare pain at 24 h and up to 14 days after proctological surgery in patients with and without a perianal block. Methods Between January 2018 and April 2019, patients were allocated to receive a perianal block with ropivacaine or placebo as an adjunct to anaesthesia. Patients, surgeons and assessors were blinded. The primary outcome was pain measured on a numerical rating scale (NRS) after 24 h. Secondary outcomes were need for rescue analgesia, and pain after 1, 2, 3, 6 and 12 h. The mean, rest and maximum NRS scores were measured for 14 days. Results A total of 138 patients were included, of whom 46 and 44 received general anaesthesia with or without ropivacaine respectively, and 23 and 25 received spinal anaesthesia with or without ropivacaine respectively (P = 0·858). The mean NRS score differed significantly at 24 h (mean(s.d.) 1·1(0·1) versus 2·3(0·2); P < 0·001), but not at 1 h (1·4(0·2) versus 2·2(0·3); P = 0·051). The NRS score was lower with use of ropivacaine at 2 h (1·0(0·2) versus 1·6(0·2); P = 0·045), 3 h (0·9(0·2) versus 1·5(0·2); P = 0·022), 6 h (1·1(0·2) versus 1·8(0·2); P = 0·042) and 12 h (1·2(0·2) versus 1·8(0·2); P = 0·034). The use of oral morphine equivalents was 10·2(1·4) and 16·6(2·5) mg with and without ropivacaine respectively (P = 0·028). The mean and maximum NRS scores within 14 days were lower when ropivacaine was used (95 per cent c.i. for difference 0·14 to 0·49 (P = 0·002) and 0·39 to 0·63 (P < 0·001) respectively). There was no injection‐associated morbidity. Conclusion Perianal block as an adjunct to general or regional anaesthesia should be recommended for proctological surgery. It yields a reduction in pain, a reduced need for opioids, and a faster recovery with minimal risk of adverse events. Registration number: NCT03405922 ( http://www.clinicaltrials.gov).

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The Effect of Pudendal Block on Voiding After Hemorrhoidectomy

Abstract: A pudendal nerve block with bupivacaine results in fewer postoperative voiding complications and less pain compared with the traditional spinal anesthesia in a hemorrhoidectomy.

Cited by 58 publications

References 15 publications

Pudendal nerve blocks in men undergoing urethroplasty: a case series

Pudendal nerve blocks in men undergoing urethroplasty: a case series

Pain Management Following Anorectal Surgery Using Patient- Controlled Analgesia vs. Pudendal Nerve Block: A Clinical Trial

Perianal block with ropivacaine as a supplement to anaesthesia in proctological surgery: double-blind randomized placebo-controlled trial (PERCEPT)

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