Ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy: a double-blind randomized controlled trial

Giuseppe, Matteo Di; Saporito, Andrea; Regina, Davide La; Tasciotti, Edoardo; Ghielmini, Enea; Vannelli, Alberto; Pini, Ramon; Mongelli, Francesco

doi:10.1007/s00384-020-03630-x

Cited by 17 publications

(41 citation statements)

References 22 publications

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“…A systematic review involving seven studies was conducted to evaluate the efficacy and safety of PNB on postoperative analgesia of hemorrhoids. Although there is no guideline or international standard about the application of PNB in hemorrhoid surgery, a considerable number of clinical trials demonstrated its effectiveness as assessed by VAS (12). Therefore, VAS score was used in this systematic review to reflect the efficacy of PNB or control.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

Li¹,

Hua²,

Qin³

et al. 2021

Ann Palliat Med

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Pudendal nerve block (PNB) is one of the common anesthesia methods, which has been widely applied in postoperative analgesia of hemorrhoids in recent years. To analyze the effectiveness and safety of PNB on postoperative analgesia of hemorrhoids, we conducted a systematic review of 7 randomized controlled trials (RCT) searched from PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), the China Network Knowledge Infrastructure (CNKI), the Wan Fang Database and Chinese Biomedicine (CBM), which were published before 7th September, 2020, and involved a total of 560 participants. We evaluated the function of PNB in improving outcomes of postoperative analgesia of hemorrhoids. Visual analogue scale (VAS) scores on postoperative 6, 12, 24, 48 h and the first time of defecation were enhanced by the application of PNB. The incidence of urinary retention, the need for analgesics [odds ratio (OR), 0.11; 95% CI, 0.04-0.37; P=0.0003] and the incidence of side effects (OR, 0.12; 95% CI, 0.04-0.39; P=0.004) in patients receiving PNB were lower than those of controls. In addition, there was no significant difference in the incidence of bleeding between groups. PNB could effectively relieve postoperative pain of hemorrhoids and reduce complications without increasing the incidence of side effects. Our results still need to be confirmed by high-quality, multi-center clinical studies.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

Li¹,

Hua²,

Qin³

et al. 2021

Ann Palliat Med

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“…Patients undergoing Milligan-Morgan hemorrhoidectomy from January 2018 to December 2019 were included and randomized to undergo spinal anesthesia either with or without the PNB. Details on patient selection and analyses methods have been reported in the previous publication by Di Giuseppe et al 11 Among its secondary endpoints, a post-hoc cost-effectiveness analysis based on the code and TARMED reimbursement system in Switzerland was planned and represents the topic of this study.…”

Section: Methodsmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Mongelli¹,

Lucchelli²,

Regina³

et al. 2021

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Background Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. Methods From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Results Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of −243 ± 881 EUR/pain unit on the VAS. Conclusion Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.

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“…Local infiltration anesthesia can provide certain postoperative analgesia without increasing the incidence of urinary retention, but it cannot provide complete muscle relaxation [9]. In recent years, spinal anesthesia combined with pudendal nerve block (PNB) has been performed for hemorrhoidectomy and it could decrease postoperative pain [10]. However, this anesthesia technique could not decrease the incidence of postoperative urinary retention.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Pain Research and Management

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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.

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Ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy: a double-blind randomized controlled trial

Cited by 17 publications

References 22 publications

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

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

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

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