Pudendal nerve block for post-opertive pain following per-anal surgeries in non-suppurative conditions

Abstract

Objective: To compare patient outcomes of pain scores, time to first mobilization, need for intravenous opioids and mean hospital stay in patients receiving bilateral pudendal nerve block versus those receiving intravenous analgesia undergoing hemorrhoidectomy

Methodology: This Quasi-experimental study was conducted at department of surgery, Combined Military Hospital, Multan from February 2024-December 2024. The patients were randomized into two groups of 80 patients each. Group A (n=80) to receive bilateral pudendal nerve block and Group-B (n=80) to receive intravenous analgesia in the form of opioids. Primary variables studied were median pain scores on the Visual Analog scale assessed at 6, 12, 24 and 36 hours. Secondary variables of study were need for rescue opioid analgesia and mean hospital stay. Mean total dose of IV Nalbuphine used till discharge was 13.44±5.87 mg versus 38.94±6.34 mg (p<0.001). Mean hospital stay was 2.35±0.48 days versus 3.76±0.55 days (p<0.001)

Results: Median pain scores assessed post-operatively after spinal effect wore off showed that pain scores between both groups were 2.00 (1.00) versus 4.00 (2.00) at 6 hours (p<0.001), scores were 3.00 (1.00) versus 3.00 (1.00) at 12 hours (p=0.415), scores were 4.0 (1.00) versus 5.00 (1.00) at 24 hours (p<0.001) and scores were 4.00 (1.00) versus 4.00 (2.00) at 36 hours (p=0.081).

Conclusion: The study concludes that PNB is associated with lesser pain scores, lesser duration of admission and lower need of opioids as rescue analgesia in patients undergoing hemorrhoidectomies.