Singh Varun K, Gupta Anju, Gupta Amita, Choudhuri Pratiti, Gangwal Maansi
Department of Anesthesiology, Critical Care and Pain Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, IND.
Cureus. 2024 Nov 22;16(11):e74244. doi: 10.7759/cureus.74244. eCollection 2024 Nov.
Caudal block is an effective regional anesthesia technique for perineal surgeries but is associated with various adverse effects. Recently, pudendal nerve block has emerged as a promising alternative for these procedures. This study assessed the effectiveness of a novel transperineal technique for ultrasound-guided pudendal nerve block and compares it with ultrasound-guided caudal block for perineal surgeries in pediatric patients.
The study included 60 American Society of Anesthesiologists (ASA) Physical Status Classification System grade I/II children aged 1-12 years and scheduled for elective perineal operations under general anesthesia. Patients were randomly allocated to two equal groups: Group C (ultrasound-guided caudal block) and Group P (ultrasound-guided pudendal nerve block). The groups were evaluated for time to first rescue analgesia (primary outcome), block performance time, total analgesic consumption, Face, Legs, Activity, Cry, and Consolability (FLACC) scores, time to achieve a Post-Anesthetic Discharge Scoring System (PADSS) score of 9, and any complications.
The median interquartile range (IQR) first rescue analgesia time was significantly higher in the pudendal block (17.5 (17-18) hours vs 4.65 (4.5-4.77) hours; p<0.001). The median (IQR) dose of postoperative analgesia (diclofenac) required was similar in the pudendal block group and caudal group (10 (0-10) mg vs 10 (0-20) mg; p=0.290). The median (IQR) FLACC scores at "zero" hour post-surgery were 2 (2-2) and 2 (1-2) in the pudendal and caudal groups, respectively (p=0.052). The median (IQR) PADDS score was significantly higher in the pudendal group (10 (9.25-10) vs 9 (8-9); p<0.001). The time to reach a PADSS score of 9 was significantly longer in the pudendal group (21.4±3 vs 14.9±4.8 hours; p<0.0001). There were no complications in either group.
The findings of this study suggest that pudendal nerve block provides longer-lasting analgesia, lower pain scores, and faster readiness for discharge though with a similar analgesic consumption compared to caudal block. These results indicate the potential of ultrasound-guided pudendal nerve blocks as a beneficial and safe alternative to caudal block for perineal procedures in children.
骶管阻滞是一种用于会阴手术的有效区域麻醉技术，但会产生各种不良反应。最近，阴部神经阻滞已成为这些手术的一种有前景的替代方法。本研究评估了一种新型经会阴超声引导阴部神经阻滞技术的有效性，并将其与超声引导骶管阻滞用于小儿会阴手术进行比较。
该研究纳入了60例年龄在1至12岁、美国麻醉医师协会（ASA）身体状况分级为I/II级、计划在全身麻醉下进行择期会阴手术的儿童。患者被随机分为两组，每组30例：C组（超声引导骶管阻滞）和P组（超声引导阴部神经阻滞）。评估两组首次补救镇痛时间（主要结局）、阻滞操作时间、总镇痛药物消耗量、面部、腿部、活动、哭闹和安慰度（FLACC）评分、达到麻醉后出院评分系统（PADSS）9分的时间以及任何并发症。
阴部神经阻滞组首次补救镇痛时间的中位数四分位数间距（IQR）显著更长（17.5（17 - 18）小时对4.65（4.5 - 4.77）小时；p<0.001）。阴部神经阻滞组和骶管阻滞组术后所需镇痛（双氯芬酸）剂量的中位数（IQR）相似（10（0 - 10）mg对10（0 - 20）mg；p = 0.290）。术后“0”小时阴部神经阻滞组和骶管阻滞组的FLACC评分中位数（IQR）分别为2（2 - 2）和2（1 - 2）（p = 0.052）。阴部神经阻滞组的PADSS评分中位数（IQR）显著更高（10（9.25 - 10）对9（8 - 9）；p<0.001）。阴部神经阻滞组达到PADSS 9分的时间显著更长（21.4±3对14.9±4.8小时；p<0.0001）。两组均无并发症发生。
本研究结果表明与骶管阻滞相比，阴部神经阻滞提供了更持久的镇痛、更低疼痛评分以及更快的出院准备，尽管镇痛药物消耗量相似。这些结果表明超声引导阴部神经阻滞作为小儿会阴手术中骶管阻滞的一种有益且安全的替代方法具有潜力。
