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Canadian Journal of Anesthesia 52:773-774 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

REPLY

Zoher Naja, MD

Makassed General Hospital, Beirut, Lebanon, E-mail: zouhnaja{at}yahoo.com

Thank you for the opportunity to respond to this letter. I was pleased to learn that pudendal nerve blocks are used for gynecological surgeries. We currently use our modified pudendal nerve block for patients undergoing hemorrhoidectomy.1 Even with the local anesthetic mixture we were injecting at each point, we did not observe any postoperative ambulatory complication that might have been due to the sciatic blockade secondary to extension of local anesthetic mixture, as a potential risk identified by Dr. Bolandard.

Depending upon the topographical anatomy, one can select any pudendal nerve branch along its trajectory of specific inferior rectal nerves, confirmed by the observation of corresponding motor responses.

With the purpose of identifying an appropriate stimulation level of the pudendal nerve and its inferior rectal nerve and perineal branches as manifest by ipsilateral contraction of the posterior aspect of the anal sphincter, we had to decide on the posterior injection points. The selection of the anterior injection points was based upon the observation of the more anterior aspects of the ipsilateral anal sphincter, and also of the superficial transversalis perineal muscle, in order to maximize the anesthetized area for surgery. Our randomized study demonstrated the effectiveness of a modified pudendal block based upon a better understanding of the topographical anatomy of this area, in reducing postoperative pain among hemorrhoidectomy patients. The use of the selected double injection points side by side proved efficacious in managing post hemorrhoidectomy pain, which can be quite severe.

Reference

1 Naja Z, Ziade MF, Lonnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain. Can J Anesth 2005; 52: 62–8.[Abstract/Free Full Text]


Related articles in CJA:

Nerve stimulator guided pudendal nerve blocks
Franck Bolandard and Jean-Étienne Bazin
CJA 2005 52: 773. [Full Text]  




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