Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Int J Colorectal Dis. 2020 Sep;35(9):1741-1747. doi: 10.1007/s00384-020-03630-x. Epub 2020 May 30.
In this double-blind randomized trial, we aimed to compare the postoperative pain, complications, and length of hospital stay in patients undergoing open hemorrhoidectomy under spinal anesthesia with or without the pudendal nerve block.
Patients undergoing Milligan-Morgan hemorrhoidectomy under spinal anesthesia were randomized to undergo a pudendal nerve block or no intervention. Postoperative pain on the visual analogue scale (VAS) at 6, 12, 24, and 48 h; opioid administration; and length of hospital stay were recorded and analyzed.
Over the study period, 49 patients were included and 23 randomized in the treatment arm. No differences in terms of age, gender, and preoperative risk factors were noted between groups. The pain on the VAS at 6, 12, 24, and 48 h was 2.8 vs. 4.6 (p = 0.046), 3.4 vs. 4.7 (p = 0.697), 1.4 vs. 3.1 (p = 0.016), and 1.0 vs. 2.1 (p = 0.288) in the treatment and control groups respectively. No differences in opioids use or complications were noted. Length of hospital stay was 1.2 vs. 1.8 days respectively (p = 0.046). No complications directly associated to the pudendal nerve block were observed. Multivariate analysis revealed that the pudendal nerve block was an independent factor reducing the postoperative pain.
The ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy under spinal anesthesia showed a statistically significant reduction in postoperative pain and length of hospital stay. The proposed technique appeared to be safe and feasible and may be recommendable in patients undergoing open hemorrhoidectomy.
ClinicalTrials.gov Identifier: NCT04251884.
在这项双盲随机试验中，我们旨在比较接受椎管内麻醉下开放式痔切除术的患者中，行阴部神经阻滞与不行阴部神经阻滞的术后疼痛、并发症和住院时间。
接受椎管内麻醉下 Milligan-Morgan 痔切除术的患者随机分为阴部神经阻滞组或无干预组。记录和分析术后 6、12、24 和 48 小时视觉模拟量表（VAS）上的术后疼痛、阿片类药物的使用和住院时间。
在研究期间，纳入了 49 例患者，其中 23 例随机分配到治疗组。两组在年龄、性别和术前危险因素方面无差异。VAS 上的疼痛在 6、12、24 和 48 小时分别为 2.8 对 4.6（p = 0.046）、3.4 对 4.7（p = 0.697）、1.4 对 3.1（p = 0.016）和 1.0 对 2.1（p = 0.288），治疗组和对照组分别为 1.2 对 1.8 天（p = 0.046）。两组间阿片类药物的使用或并发症无差异。住院时间分别为 1.2 对 1.8 天（p = 0.046）。未观察到与阴部神经阻滞直接相关的并发症。多变量分析显示，阴部神经阻滞是减少术后疼痛的独立因素。
在接受椎管内麻醉下开放式痔切除术的患者中，超声引导阴部神经阻滞可显著减轻术后疼痛和缩短住院时间。该技术似乎安全可行，可推荐用于接受开放式痔切除术的患者。
ClinicalTrials.gov 标识符：NCT04251884。
