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Pudendal Block with Bupivacaine for Postoperative Pain Relief

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Diseases of the Colon & Rectum

Purpose

Postoperative pain after hemorrhoidectomy is very intense, and the pain at the first postoperative defecation is very intense. Based on our pilot initial results that reflected reduced postoperative pain, we conducted a prospective, randomized, double-blind study to investigate whether the analgesia produced by bilateral pudendal nerve block using a nerve-stimulator could provide better postoperative pain relief compared with the routine technique in use in the Department of Anesthesia.

Methods

After Ethical Committee approval and informed consent, 100 patients scheduled for hemorrhoidectomy were randomized into control (C) and study (P) groups with 50 patients each. Bilateral pudendal nerve block with 0.25 percent bupivacaine was performed with nerve-stimulator. Evaluated parameters were pain severity, duration of analgesia, demand analgesia, and possible technique-related complications. Data were evaluated 6, 12, 18, and 24 hours after surgery completion. The first defecation and patient satisfaction were recorded.

Results

Successful pudendal nerves stimulation was achieved in all patients in the study group. The pudendal nerve block group was found to have better postoperative pain relief, reduced need for analgesics, and patient satisfaction. Mean analgesic duration was 23.8 ± 4.8 hours vs. 3.6 ± 1 hours. All patients in the pudendal nerve block had spontaneous micturition vs. 48 patients in the control group. The pudendal analgesia was considered excellent by 44 patients and satisfactory by 6 male patients. The six male patients complained because of penile anesthesia. No anesthetic-related local or systemic complications were observed.

Conclusions

In this controlled study, bilateral pudendal nerve block oriented by nerve stimulator provided excellent analgesia with low need for opioids, without local or systemic complications, and without urinary retention.

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Authors and Affiliations

  1. Institute for Regional Anesthesia, Hospital de Base da FAMERP, São José do Rio Preto, SP, Brazil

    Luiz Eduardo Imbelloni M.D. (Director), Eneida Maria Vieira M.D. (Director), Marildo A. Gouveia M.D. (Director), João Gomes Netinho M.D. (Head), Luciano Dechichi Spirandelli M.D. & José Antonio Cordeiro Ph.D. (Professor)

  2. Discipline of Coloproctology of the School of Medicine da FAMERP, São José do Rio Preto, SP, Brazil

    João Gomes Netinho M.D. (Head)

  3. School of Medicine da FAMERP, São José Rio Preto, SP, Brazil

    José Antonio Cordeiro Ph.D. (Professor)

  4. Av. Epitácio Pessoa, 2356/203, 22411-072, Rio de Janeiro, Brazil

    Luiz Eduardo Imbelloni M.D. (Director)

Authors
  1. Luiz Eduardo Imbelloni M.D.
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  2. Eneida Maria Vieira M.D.
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  3. Marildo A. Gouveia M.D.
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  4. João Gomes Netinho M.D.
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  5. Luciano Dechichi Spirandelli M.D.
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  6. José Antonio Cordeiro Ph.D.
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Correspondence to Luiz Eduardo Imbelloni M.D..

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Imbelloni, L.E., Vieira, E.M., Gouveia, M.A. et al. Pudendal Block with Bupivacaine for Postoperative Pain Relief. Dis Colon Rectum 50, 1656–1661 (2007). https://doi.org/10.1007/s10350-007-0216-7

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  • DOI: https://doi.org/10.1007/s10350-007-0216-7

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