Schenck M, Kliner S J, Achilles M, Schenck C, Berkovic K, Ruebben H, Stuschke M
Urologische Universitätsklinik, Universitätsklinikum der Universität Duisburg-Essen, Hufelandstrasse 55, Essen.
Aktuelle Urol. 2010 Jan;41(1):43-51. doi: 10.1055/s-0029-1224722. Epub 2009 Nov 30.
In male patients the pudendal block has been applied only in rare cases as a therapy for neuralgia of the pudendal nerve. Up to now there is no comparison of pudendal block with an anaesthesia form close to the spinal cord. In this pilot study the bilateral perineal infiltration of the pudendal nerve was compared to combined spinal-epidural anaesthesia in high-dose-rate (HDR) brachytherapy.
In 30 patients (68.8 +/- 5.4 years) who underwent a core needle biopsy for high-risk prostate carcinoma, an HDR brachytherapy in CSE or NPB was carried out. Both anaesthesia forms were examined concerning the perioperative compatibility, the subjective feeling (German school marks principle 1-6), the pain feeling (VAS, 1-10) and the early postoperative course (mobility, complications).
Both anaesthesia procedures were offered to all patients. For 2 patients the NPB was favoured primarily, because they had undergone surgery of the lumbal spine, so that the CSE was not applicable. There was no change of anaesthesia form necessary. The expense of time for NPB was 10.5 +/- 2.5 min, for CSE 30.5 +/- 5.5 min (p < 0.005). The hollow needles remained in place on average for 79 +/- 11.7 min (p = 0.23). Inter- and postoperative pain feelings were in both groups between 1.3 +/- 1.1 and 1.1 +/- 1.0 (p = 0.61 and p = 0.29). The difference is not significant. The NPB group considered postoperative mobility as an advantage. All patients felt the bladder catheter as annoying, but the NPB group considered postoperative mobility as more important than complete lack of pain. The subjective feeling in the NPB group was described as 2.06 +/- 0.59 and in the CSE group 2.73 +/- 0.79. This is a significant difference (p < 0.005). No side effects or complications in both anaesthesia forms appeared.
The perineal pudendal block is equivalent to epidural anaesthesia in HDR brachytherapy. Concerning the objectifiable pain score measurement and the subjective feeling there are no essential significant differences.
在男性患者中，阴部神经阻滞仅在极少数情况下用于治疗阴部神经痛。到目前为止，尚无阴部神经阻滞与接近脊髓的麻醉形式的比较。在这项初步研究中，将双侧阴部神经会阴浸润与高剂量率（HDR）近距离放射治疗中的腰麻-硬膜外联合麻醉进行了比较。
对30例（68.8±5.4岁）因高危前列腺癌接受粗针活检的患者进行了腰麻-硬膜外联合麻醉或阴部神经阻滞下的HDR近距离放射治疗。对两种麻醉方式的围手术期耐受性、主观感受（德国学校评分原则1-6）、疼痛感受（视觉模拟评分法，1-10）及术后早期病程（活动度、并发症）进行了检查。
两种麻醉方法均提供给所有患者。2例患者主要选择阴部神经阻滞，因为他们接受过腰椎手术，所以不能进行腰麻-硬膜外联合麻醉。无需改变麻醉方式。阴部神经阻滞的耗时为10.5±2.5分钟，腰麻-硬膜外联合麻醉为30.5±5.5分钟（p<0.005）。空心针平均留置79±11.7分钟（p=0.23）。两组术中和术后的疼痛感受均在1.3±1.1至1.1±1.0之间（p=0.61和p=0.29）。差异无统计学意义。阴部神经阻滞组认为术后活动度是一个优势。所有患者都觉得膀胱导管很烦人，但阴部神经阻滞组认为术后活动度比完全无痛更重要。阴部神经阻滞组的主观感受评分为2.06±0.59，腰麻-硬膜外联合麻醉组为2.73±0.79。这是一个显著差异（p<0.005）。两种麻醉方式均未出现副作用或并发症。
在HDR近距离放射治疗中，会阴阴部神经阻滞等同于硬膜外麻醉。在可客观测量的疼痛评分和主观感受方面，没有本质上的显著差异。
