Department of Proctology, Pelvic Floor Disease Center, Seoul Song Do Colorectal Hospital, Seoul, Korea.
Colorectal Dis. 2012 May;14(5):611-5. doi: 10.1111/j.1463-1318.2011.02720.x.
Various techniques have been described for performing a pudendal nerve block (PNB) and have associated problems such as multiple needle injections, the need for special equipment and consumption of time. This study aimed to describe a nerve-stimulator-guided PNB using a pararectal approach and to evaluate the safety and the efficacy of that procedure.
We conducted a prospective study of 53 patients who underwent a PNB from December 2009 to July 2010. With the index finger of the left hand inserted into anus, we guided the nerve stimulator needle along the second finger tip on the ischial spine to the site where the maximal contraction of the external anal sphincter could be felt. Once the position of the needle tip had been confirmed, the desired drug was injected. Of the 53 patients, a cohort of eight underwent manometry before and after the pudendal block.
A total of 53 patients underwent the nerve-stimulator-guided procedure: 13 patients for pudendal neuralgia and the other 40 patients for anorectal disease. The mean maximal resting and squeezing pressures before the block were 55 and 161 mmHg, respectively, compared with 35 and 67 mmHg after the block. The PNB took just minutes to perform, was well tolerated by the patients, and resulted in neither severe complications nor repeated attempts.
Nerve-stimulator-guided PNB using a pararectal approach proved to be easy and safe, with acceptable patient tolerance. In addition, it can be used for a variety of anorectal procedures where relaxation of anal tone is required.
已有多种技术被用于实施阴部神经阻滞（PNB），但这些技术都存在一些问题，如多次进针、需要特殊设备以及耗费时间等。本研究旨在描述一种经直肠旁入路行阴部神经刺激器引导阻滞（PNB）的方法，并评估该方法的安全性和有效性。
我们进行了一项前瞻性研究，纳入了 2009 年 12 月至 2010 年 7 月间 53 例行 PNB 的患者。左手食指插入肛门，引导神经刺激器针沿着坐骨棘的第二指尖方向进入可感觉到外括约肌最大收缩的部位。一旦确定针尖位置，即可注入所需药物。在 53 例患者中，8 例接受了阴部神经阻滞前后的测压检查。
共有 53 例患者接受了神经刺激器引导的操作：13 例为阴部神经痛，40 例为肛肠疾病。阻滞前最大静息压和收缩压分别为 55mmHg 和 161mmHg，而阻滞后分别为 35mmHg 和 67mmHg。阴部神经阻滞只需数分钟即可完成，患者耐受性良好，无严重并发症或需要重复尝试。
经直肠旁入路行阴部神经刺激器引导阻滞操作简单、安全，患者耐受性良好。此外，它可用于多种需要放松肛门张力的肛肠操作。
