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Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain

[Le bloc du nerf honteux guidé par neurostimulation diminue la douleur posthémorroïdectomie]

Zouheir Naja, MD^*, Mohammad Fouad Ziade, PhD and Per-Arne Lönnqvist, MD PhD

^* From the Department of Anaesthesia and Intensive Care, Makassed General Hospital;
the Faculty of Public Health, Lebanese University, Beirut, Lebanon; and
the Department of Anesthesia and Intensive Care, KS/Astrid Lindgren Children’s Hospital, Stockholm, Sweden.

Address correspondence to: Dr. Zouheir Naja, Department of Anesthesia and Intensive Care, Makassed General Hospital, B.O. Box: 11-6301 Riad El-Solh 11072210, Beirut, Lebanon. Phone: 961-1-655-466; Fax: 961-1-646-589; E-mail: zouhnaja{at}yahoo.com

Purpose: Based on our institution’s initial results that reflected reduced postoperative pain using a modified pudendal nerve block technique, we conducted a prospective, randomized, double-blind study to investigate whether a combination of general anesthesia and bilateral nerve stimulator guided pudendal nerve blocks could provide better postoperative pain relief compared to general anesthesia alone or in combination with placebo nerve blocks.

Methods: Following Ethical Committee approval and informed consent 90 patients scheduled for hemorrhoidectomy were randomized to three different groups of 30 patients each: general anesthesia alone, general anesthesia plus nerve stimulator guided pudendal nerve block or general anesthesia plus placebo nerve blocks. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at predetermined time intervals during the postoperative period. Total amount of analgesics, time to return to normal activities and patient satisfaction were also recorded.

Results: The pudendal nerve block group was found to have better postoperative pain-relief (P < 0.005), reduced need for analgesics (P < 0.05), and also a more rapid return to normal activities (P < 0.001) compared to general anesthesia alone or in combination with placebo blocks. The pudendal nerve block group was also associated with significantly higher patient satisfaction (P < 0.001) compared to the other two groups.

Conclusion: A combination of general anesthesia and nerve stimulator guided pudendal nerve block showed significantly reduced postoperative pain, shortened hospital stay, and earlier return to normal activity. Thus, this technique deserves more widespread use in patients undergoing hemorrhoidectomy.

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