Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy.
OBJECTIVE
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).


CONCLUSIONS
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.
Naja
Zoher
Z
Department of Anesthesia and Pain Medicine, Makassed General Hospital, P.O. Box: 11-6301 Riad El-Solh 11072210, Beirut, Lebanon. zouhnaja@yahoo.com
El-Rajab
Mariam
M
Al-Tannir
Mohamad
M
Ziade
Fouad
F
Zbibo
Riad
R
Oweidat
Mustafa
M
Lönnqvist
Per-Arne
PA
D000293:Adolescent; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D004558:Electric Stimulation; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D017060:Patient Satisfaction; D011446:Prospective Studies
D000701:Analgesics, Opioid