Department of General Surgery, School of Medicine, Muğla Sıtkı Koçman University, Muğla 48121, Türkiye.
Medicina (Kaunas). 2024 Oct 9;60(10):1651. doi: 10.3390/medicina60101651.
The selection of an appropriate anesthesia method is a critical factor in the surgical treatment of proctological diseases, significantly impacting patient outcomes and comfort. Pudendal nerve block (PNB) and spinal anesthesia (SA) are commonly employed in these surgeries, yet the optimal choice between the two remains debated. This study aims to compare the efficacy and safety of PNB and SA in patients undergoing surgical treatment for various proctological conditions, with a focus on postoperative pain management, functional outcomes, and complication rates. A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155). Pain levels were assessed using the Visual Analog Scale (VAS), while functional outcomes were measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Statistical analysis was performed to compare the outcomes between the two groups. Patients in the PNB group reported significantly lower postoperative VAS scores compared to those in the SA group, particularly in hemorrhoidectomy and laser hemorrhoidoplasty procedures. The PNB group also demonstrated superior functional outcomes, with lower postoperative WHODAS 2.0 scores and a reduced incidence of urinary retention compared to the SA group. Furthermore, the duration of surgery and hospital stay were significantly shorter for patients in the PNB group. The findings suggest that PNB may offer advantages over SA in proctological surgeries, particularly in terms of pain management, functional recovery, and reduced complication rates. PNB should be considered a viable alternative to SA, particularly in cases where rapid recovery and minimizing complications are priorities. Exceptions to this include specific proctological surgeries, such as those for malignant tumors in the region, complex anal fistulas, proctological conditions arising from inflammatory bowel diseases, and patients on immunosuppressive therapy. Further research is needed to confirm these results and optimize anesthesia selection in this context.
选择合适的麻醉方法是肛肠疾病外科治疗的关键因素，对患者的预后和舒适度有重要影响。阴部神经阻滞（PNB）和脊髓麻醉（SA）常用于此类手术，但两者之间的最佳选择仍存在争议。本研究旨在比较 PNB 和 SA 在接受各种肛肠疾病手术治疗的患者中的疗效和安全性，重点关注术后疼痛管理、功能结果和并发症发生率。
一项前瞻性观察研究纳入了 590 名接受 PNB（n = 435）或 SA（n = 155）治疗的肛肠疾病手术患者。使用视觉模拟评分（VAS）评估疼痛程度，使用世界卫生组织残疾评估量表（WHODAS 2.0）测量功能结果。采用统计学方法比较两组间的结果。
PNB 组患者术后 VAS 评分明显低于 SA 组，尤其是在痔切除术和激光痔切除术患者中。PNB 组的功能结果也更好，术后 WHODAS 2.0 评分较低，且与 SA 组相比，尿潴留的发生率更低。此外，PNB 组的手术时间和住院时间明显更短。
研究结果表明，PNB 在肛肠手术中可能优于 SA，特别是在疼痛管理、功能恢复和降低并发症发生率方面。PNB 应被视为 SA 的可行替代方案，特别是在快速恢复和尽量减少并发症的情况下。但对于该区域的恶性肿瘤、复杂肛瘘、炎症性肠病引起的肛肠疾病和接受免疫抑制治疗的患者等特定肛肠手术，SA 可能更为适用。需要进一步的研究来证实这些结果，并优化该背景下的麻醉选择。
