From the Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, Worcester, MA.
Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e465-e468. doi: 10.1097/SPV.0000000000000963.
To evaluate the effect of bilateral pudendal nerve blockade on immediate postoperative bladder emptying after midurethral sling.
We performed a double-blinded, randomized, placebo-controlled trial of women undergoing a midurethral sling procedure between October 2017 and February of 2019. Women older than 18 years were eligible if they were undergoing a midurethral sling with no concomitant procedures and had no preoperative urinary retention. Participant demographics and medical conditions that may affect bladder emptying were recorded preoperatively. Participants were randomized to a bilateral pudendal injection of either bupivacaine or normal saline. After induction of anesthesia, the pudendal injection was administered before any incisions. No other local anesthesia was used. The primary outcome was the rate of passing a standardized void trial. Secondary outcomes included perioperative pain scores, analgesia use, and complications.
Ninety-one participants were enrolled in the study. One patient had a delayed void trial on postoperative day 1, leaving 90 participants for the final analysis. Demographic and perioperative characteristics were similar between the groups. Adjusted logistic regression showed that the administration of a bupivacaine pudendal block led to a higher rate of void trial failure (43% vs 20%, odds ratio = 0.32, P = 0.02 adjusted for age, body mass index, and comorbidities). Postoperative pain scores and analgesia use were similar between the groups. Postoperative complications, including urinary tract infection, mesh erosion, pelvic hematoma, or urinary retention within 6 weeks were similar between the groups.
Our prospective trial demonstrates that a bilateral pudendal blockade before midurethral sling procedure worsens postoperative bladder emptying.
评估双侧阴部神经阻滞对尿道中段吊带术后即刻膀胱排空的影响。
我们进行了一项双盲、随机、安慰剂对照试验，纳入 2017 年 10 月至 2019 年 2 月期间接受尿道中段吊带术的女性。如果患者接受的是单纯尿道中段吊带术且无其他伴随手术、无术前尿潴留，则可入选。记录患者的术前人口统计学资料和可能影响膀胱排空的合并症。患者随机接受双侧阴部阻滞注射布比卡因或生理盐水。在麻醉诱导后，在进行任何切口之前给予阴部阻滞。未使用其他局部麻醉。主要结局为通过标准化排尿试验的比例。次要结局包括围手术期疼痛评分、镇痛药物使用情况和并发症。
本研究共纳入 91 例患者。1 例患者在术后第 1 天延迟排尿试验，最终 90 例患者纳入最终分析。组间的人口统计学和围手术期特征相似。调整后的逻辑回归显示，阴部阻滞注射布比卡因会导致排尿试验失败的比例更高（43% vs 20%，比值比=0.32，P=0.02，调整了年龄、体重指数和合并症）。组间术后疼痛评分和镇痛药物使用情况相似。术后并发症（包括 6 周内尿路感染、网片侵蚀、骨盆血肿或尿潴留）在组间相似。
我们的前瞻性试验表明，尿道中段吊带术前行双侧阴部神经阻滞会导致术后膀胱排空功能恶化。
