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Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy

[Le bloc du nerf honteux guidé par un neurostimulateur versus l’anesthésie générale pour une hémorroïdectomie]

Zoher Naja, MD^*, Mariam El-Rajab, MD, Mohamad Al-Tannir, MPH, Fouad Ziade, PhD, Riad Zbibo, MD^¶, Mustafa Oweidat, MD^¶ and Per-Arne Lönnqvist, PhD

^* From the Departments of Anesthesia and Pain Medicine,
Pediatrics,
Research Unit, and
^¶ Surgery, Makassed General Hospital;
the Faculty of Public Health, Lebanese University, Beirut, Lebanon; and the
Department of Anesthesia & Intensive Care, KS/Astrid Lindgrens Children’s Hospital, Stockholm, Sweden.

Address correspondence to: Dr. Zouheir Naja, Department of Anesthesia and Pain Medicine, Makassed General Hospital, P.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: 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 predetermined 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.

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