Pudendal Nerve Block for Posthemorrhoidectomy Pain: A Prospective, Single-Blinded Randomized Control Trial

Area of Science:

• Colorectal Surgery
• Pain Management
• Anesthesiology

Background:

• Postoperative pain is a significant concern for patients undergoing hemorrhoidectomy.
• Local anesthetics, including pudendal nerve blocks and wound infiltration, are explored for pain relief.

Purpose of the Study:

• To evaluate if adding an intraoperative pudendal nerve block to local wound infiltration improves early postoperative pain following hemorrhoidectomy.
• To assess differences in perianal numbness, opioid requirements, and adverse events between groups.

Main Methods:

• Prospective, single-blinded randomized controlled trial involving 80 hemorrhoidectomy patients across 3 Australian hospitals.
• Patients were randomized to receive either a bilateral pudendal nerve block plus local wound infiltration or local wound infiltration alone.
• Pain scores were measured using visual analogue scales; secondary outcomes included numbness, opioid use, and adverse events.

Main Results:

• No significant differences in postoperative pain scores were observed between the pudendal nerve block group and the control group at 4, 8, 12, or 24 hours.
• Perceived perianal numbness, oral opioid usage, and adverse events did not differ significantly between the two treatment groups.

Conclusions:

• The addition of a pudendal nerve block to local wound infiltration does not provide additional pain reduction benefits after hemorrhoidectomy compared to local anesthetic infiltration alone.
• Limitations include the lack of a nerve stimulator, which raises questions about the successful achievement of the pudendal nerve block.