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Nerve stimulator guided pudendal nerve blockversus general anesthesia for hemorrhoidectomy

  • Zoher Naja
  • Mariam El-Rajab
  • Mohamad Al-Tannir
  • Fouad Ziade
  • Riad Zbibo
  • Mustafa Oweidat
  • Per-Arne Lönnqvist
Regional Anesthesia And Pain

Abstract

Purpose

A randomized clinical trial was undertaken to test the hypothesis that patients receiving a nerve stimulator guided pudendal nerve block for hemorrhoidectomy would experience more effective and prolonged postoperative analgesia and shorter hospital stay compared to patients receiving general anesthesia.

Methods

This was a prospective randomized observer-blinded study. Following Ethics Committee approval and informed consent, 80 patients scheduled for hemorrhoidectomy were randomized to two groups of 40 patients each: general anesthesia alone, or nerve stimulator guided pudendal nerve block. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at pre-determined intervals during the postoperative period. Analgesic consumption, time to return to normal activities, patients’ and surgeons’ satisfaction, and duration of hospital stay were recorded.

Results

The guided pudendal nerve block group failed in three patients, requiring their conversion to general anesthesia. Otherwise, patients in the pudendal nerve block group experienced better postoperative pain relief at rest (P < 0.0001), on walking, sitting, and defecation (P < 0.001), reduced need for opioids (11/35 vs 32/37; P < 0.0001), a more rapid return to normal activities (7.2 vs 13.8 days; P < 0.0001) and also a shorter hospital stay (25/35 vs 3/37 outpatient cases; P < 0.0001) compared to the general anesthesia group. Pudendal nerve block was also associated with overall higher patient satisfaction compared to general anesthesia (30/35 vs 9/37; P < 0.0001).

Conclusion

Nerve stimulator guided pudendal nerve block is associated with reduced postoperative pain, shortened hospital stay, and earlier return to normal activity compared to general anesthesia for hemorrhoidectomy.

Keywords

Nerve Stimulator Visual Analogue Scale Score Ropivacaine Pudendal Nerve High Patient Satisfaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le bloc du nerf honteux guidé par un neurostimulateur versus ľanesthésie générale pour une hémorroïdectomie

Résumé

Objectif

Tester ľhypothèse voulant que les patients qui reçoivent un bloc du nerf honteux guidé par neurostimulation pour une hémorroïdectomie vont connaître une analgésie postopératoire plus efficace et prolongée et un plus court séjour hospitalier que ceux qui reçoivent une anesthésie générale.

Méthode

Nous avons réalisé une étude prospective, randomisée et à ľinsu de ľobservateur. Avec ľapprobation du Comité ďéthique et le consentement éclairé des participants, 80 patients devant subir une hémorroïdectomie ont été répartis en deux groupes de 40 et ont reçu une anesthésie générale ou un bloc du nerf honteux guidé par neurostimulation. La douleur postopératoire a été évaluée par les scores à ľéchelle visuelle analogique à des intervalles de temps prédéterminés après ľopération. La consommation ďanalgésique, le temps nécessaire au retour à des activités normales, la satisfaction du patient et du chirurgien et la durée du séjour hospitalier ont été notés.

Résultats

Le bloc du nerf honteux a échoué chez trois patients qui ont dû recevoir une anesthésie générale. Autrement, les patients qui ont reçu le bloc ont connu un meilleur soulagement de la douleur postopératoire au repos (P < 0,0001), lors de la marche, en position assise et à la défécation (P < 0,001), des besoins réduits ďopioïdes (11/35 vs 32/37 ; P < 0,0001), un retour plus rapide aux activités normales (7,2 vs 13,8 jours ; P < 0,0001) et aussi un séjour hospitalier plus court (25/35 vs 3/37 cas ambulatoires ; P < 0,0001) comparés à ceux qui ont reçu une anesthésie générale. Le bloc du nerf honteux a été aussi associé à une plus grande satisfaction globale (30/35 vs 9/37 ; P< 0,0001).

Conclusion

Le bloc du nerf honteux guidé par neurostimulation comparé à ľanesthésie générale pour une hémorroïdectomie est associé à une réduction de la douleur postopératoire, à un plus court séjour hospitalier et à un retour précoce aux activités normales.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Zoher Naja
    • 1
  • Mariam El-Rajab
    • 2
  • Mohamad Al-Tannir
    • 3
  • Fouad Ziade
    • 5
  • Riad Zbibo
    • 4
  • Mustafa Oweidat
    • 4
  • Per-Arne Lönnqvist
    • 6
  1. 1.Departments of Anesthesia and Pain MedicineMakassed General HospitalBeirut
  2. 2.Departments of PediatricsMakassed General HospitalBeirut
  3. 3.Departments of Research UnitMakassed General HospitalBeirut
  4. 4.Departments of SurgeryMakassed General HospitalBeirut
  5. 5.Faculty of Public HealthLebanese UniversityBeirut
  6. 6.Department of Anesthesia & Intensive CareKS/Astrid Lindgrens Children’s HospitalStockholmSweden

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