Nerve stimulator-guided pudendal nerve block vs general anesthesia for postoperative pain management after anterior and posterior vaginal wall repair: a prospective randomized trial.
OBJECTIVE
Compare the effectiveness of nerve stimulator-guided pudendal nerve block (PNB) vs general anesthesia (GA) for anterior and posterior (AP) colporrhaphy in terms of pain relief and analgesic consumption within 24 and 48 hours postoperatively.


METHODS
Prospective randomized trial.


METHODS
Fifty-seven patients whose ages ranged between 20 and 53 years scheduled to undergo AP colporrhaphy due to the presence of cystorectocele.


METHODS
Patients were randomly assigned into 2 groups receiving either nerve stimulator-guided PNB (n = 28) or GA (n = 29). A total volume of 0.7 mL/kg of the local anesthetic mixture was injected at 4 sites.


RESULTS
Both groups were similar with respect to age, weight, height, and surgery duration. There was a significant difference in average pain scores within the first and second postoperative days (P values = .005 and .004, respectively). Total analgesic consumption (ketoprofen and tramadol) was significantly lower in the PNB within the first (P values = .018 and .010) and second postoperative days (P values = .041 and .011), respectively. Return to normal daily activity was significantly (P< .0001) shorter in the PNB group compared with the GA group (3.6 days vs 12.2 days). A total of 71.4% of the patients in the PNB group were satisfied compared with 27.8% in the GA group (P< .0001). Surgeon satisfaction was significantly higher in the PNB group (82.1% vs 34.5%, P< .0001).


CONCLUSIONS
This randomized controlled trial demonstrated that nerve stimulator-guided PNB could be used as an alternative to GA for AP repair of stages I and II prolapse because it is associated with less postoperative pain and analgesic consumption, in addition to shorter duration of recovery.
OB-GYN Department, Makassed General Hospital, Beirut, Lebanon. Electronic address: imankhalil80@hotmail.com.
Iman
I
Khalil
OB-GYN Department, Makassed General Hospital, Beirut, Lebanon. Electronic address: drsaad50@hotmail.com.
Saad E
SE
Itani
American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: zn16@aub.edu.lb.
Zeina
Z
Naja
Lebanese American University, Beirut, Lebanon. Electronic address: ahmadnaja90@hotmail.com.
Ahmad Salah
AS
Naja
Faculty of Public Health, Lebanese University, Beirut, Lebanon. Electronic address: fouadziade@hotmail.com.
Fouad M
FM
Ziade
OB-GYN Department, Hôpital Foch, Suresnes, France. Electronic address: jm.ayoubi@hopital-foch.org.
Jean-Marc
JM
Ayoubi
Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon. Electronic address: drmariam1@hotmail.com.
Mariam A
MA
El-Rajab
Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon. Electronic address: zouhnaja@yahoo.com.
Zoher M
ZM
Naja
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D052858:Cystocele / Q000601:surgery*; D004558:Electric Stimulation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D060525:Pudendal Nerve / Q000187:drug effects*; D020047:Rectocele / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*
D000779:Anesthetics, Local
Analgesic consumption; Nerve stimulator; Pudendal nerve block