1 Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland 2 Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland 3 Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Dis Colon Rectum. 2021 May;64(5):617-631. doi: 10.1097/DCR.0000000000001985.
Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.
The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.
PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.
Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.
Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.
Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.
The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292-0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, -0.935; 95% CI, -1.280 to -0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, -1.862; 95% CI, -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, -0.742; 95% CI, -1.145 to -0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062-0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged "high."
Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.
This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
术后疼痛是传统痔切除术的一个重要问题。特别是在日间手术环境中，需要进行最佳的疼痛控制。
本研究旨在探讨阴部神经阻滞在痔切除术患者中的应用。
检索了 PubMed、Google Scholar、Cochrane 图书馆和 Web of Science 数据库，检索时间截至 2020 年 12 月。
选择了评估阴部神经阻滞对痔切除术患者影响的随机试验。
全身麻醉或脊髓麻醉下进行痔切除术，联合或不联合阴部神经阻滞。
阿片类药物的消耗、视觉模拟量表上的疼痛、住院时间和再入院率是主要观察指标，并采用随机效应模型进行绘图。
文献检索共发现 749 篇文章，其中 14 篇被认为符合纳入标准。共纳入 1214 例患者，其中 565 例接受了阴部神经阻滞。在痔切除术后，阴部神经阻滞组患者接受阿片类药物的频率更低（相对风险，0.364；95%CI，0.292-0.454，p<0.001），累积剂量也更低（标准化均数差，-0.935；95%CI，-1.280 至-0.591，p<0.001）。此外，这些患者在 24 小时时疼痛程度更低（标准化均数差，-1.862；95%CI，-2.495 至-1.228，p<0.001），住院时间更短（标准化均数差，-0.742；95%CI，-1.145 至-0.338，p<0.001），再入院率更低（相对风险，0.239；95%CI，0.062-0.916，p=0.037）。敏感性分析排除了主要终点出现发表偏倚的情况，整体证据质量被判断为“高”。
本研究的一些次要终点存在发表偏倚的可能性，且存在异质性。
本系统评价和荟萃分析表明阴部神经阻滞具有显著优势。可以证明阴部神经阻滞能减少阿片类药物的消耗、术后疼痛、并发症和住院时间。尽管存在局限性，但在痔切除术患者中应考虑使用阴部神经阻滞。
