title: The effect of preemptive pudendal nerve blockade on pain after transvaginal pelvic reconstructive surgery.
abstract: OBJECTIVE
  To assess the effect of preemptive pudendal nerve blockade on pain and consumption of narcotic analgesia following transvaginal pelvic reconstructive surgery.
  
  
  METHODS
  This was a randomized, double-blind, placebo-controlled trial. Patients undergoing transvaginal pelvic reconstructive surgery under general anesthesia were randomized to receive pudendal block with either bupivacaine 0.25% or placebo (normal saline 0.9%) immediately before surgery. All patients received postoperative intravenous hydromorphone patient-controlled analgesia. Patients were asked to report on their pain intensity 1, 3, 5, 7, 18, and 24 hours postoperatively, using a validated visual analog pain scale from 0-10. Main outcome measures included postoperative pain intensity and hydromorphone consumption.
  
  
  RESULTS
  One hundred ten patients enrolled in the study, of whom 106 underwent randomization, and 102 received pudendal nerve blockade, 51 with bupivacaine and 51 with saline. Demographic and baseline clinical characteristics were not significantly different between the 2 patients groups. There were no significant differences in postoperative pain intensity (median scores: 1 hour, 4.0 versus 5.0; 3 hours, 3.0 versus 4.0; 7 hours, 2.0 versus 3.0; 18 hours, 3.0 versus 4.0), the consumption of hydromorphone (0-3 hours, 1.84 mg versus 1.77 mg; 4-7 hours, 1.19 mg versus 1.20 mg; 8-18 hours, 2.89 mg versus 2.35 mg), or mean hospital stay (39.6 versus 37.3 hours) between the bupivacaine and saline groups.
  
  
  CONCLUSIONS
  Preemptive pudendal nerve blockade does not affect postoperative pain intensity or the consumption of narcotic analgesia after transvaginal pelvic reconstructive surgery.
authors.affiliation: Division of Urogynecology, Evanston Continence Center, and Division of Anesthesia, Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA. y-abramov@northwestern.edu
authors.forename: Yoram
authors.initials: Y
authors.lastname: Abramov
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sand
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Botros
authors.forename: Jay-James R
authors.initials: JJ
authors.lastname: Miller
authors.forename: Eun-Kyu
authors.initials: EK
authors.lastname: Koh
authors.forename: Roger P
authors.initials: RP
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017699:Pelvic Pain / Q000209:etiology / Q000517:prevention & control*; D010388:Pelvis / Q000601:surgery*; D011300:Preoperative Care; D014621:Vagina / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine