Pan Peng, Jiang Jingjing, Zhang Xiaoyun, Yang Wang, Ding Wengang
Department of Anesthesiology, Heilongjiang Key Laboratory of Anesthesiology and Intensive Care Research & Key Laboratory for Basic Theory and Application of Anesthesiology of the Heilongjiang Higher Education Institution, the Second Affiliated Hospital of Harbin Medical University, No. 148, BaoJian Road, Harbin, 150086, China.
Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Int J Colorectal Dis. 2025 Jul 17;40(1):159. doi: 10.1007/s00384-025-04953-3.
The study aimed to evaluate the efficacy of ultrasound-guided pudendal nerve block (PNB) versus local anesthetic infiltration (LAI) in managing the pain.
This is a prospective, randomized, double-blinded trial, 78 patients undergoing procedure for prolapse and hemorrhoids (PPH) were randomly allocated to receive either ultrasound-guided PNB or LAI. Primary outcomes were postoperative pain scores using the visual analogue scale at multiple time points within the first 48 h. Secondary outcomes included tramadol consumption, incidence of postoperative nausea and vomiting, and quality of recovery-15 (QoR-15) scores.
The trial ultimately involved 71 patients. Results showed that the PNB group had significantly lower pain scores at 6, 12, and 18 h postoperatively compared with the LAI group (all P < 0.01), with no significant differences noted at 24 and 48 h. PNB group also had fewer patients requiring supplemental tramadol (5/36) than the LAI group (12/35) (P < 0.05) and experienced a delayed onset of pain (13.83 ± 11.21 h vs. 6.94 ± 2.88 h; P < 0.001). Furthermore, the incidence of anal sphincter spasms was lower in the PNB group (5/36) compared with the LAI group (12/35) (P < 0.04). QoR-15 scores at 24 h postoperatively were significantly higher in the PNB group (119.11 ± 5.87) compared with the LAI group (112.03 ± 7.04) (P < 0.05), indicating a better early recovery experience. Patient satisfaction was higher in the PNB group (28/36 vs. 22/35, P < 0.05).
Ultrasound-guided PNB was more effective than LAI in pain control and recovery quality. It can be considered an effective method for postoperative pain management in patients undergoing PPH surgery.
This study was registered with the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ , Registration No. ChiCTR-IPR-15006427) on May 21, 2015.
本研究旨在评估超声引导下阴部神经阻滞（PNB）与局部麻醉药浸润（LAI）在疼痛管理中的疗效。
这是一项前瞻性、随机、双盲试验，78例接受痔上黏膜环切术（PPH）的患者被随机分配接受超声引导下PNB或LAI。主要结局是术后48小时内多个时间点使用视觉模拟量表的疼痛评分。次要结局包括曲马多消耗量、术后恶心呕吐发生率和恢复质量-15（QoR-15）评分。
该试验最终纳入71例患者。结果显示，与LAI组相比，PNB组术后6、12和18小时的疼痛评分显著更低（均P<0.01），24和48小时无显著差异。PNB组需要补充曲马多的患者也比LAI组少（5/36比12/35）（P<0.05），且疼痛发作延迟（13.83±11.21小时对6.94±2.88小时；P<0.001）。此外，PNB组肛门括约肌痉挛的发生率低于LAI组（5/36比12/35）（P<0.04）。术后24小时PNB组的QoR-15评分显著高于LAI组（119.11±5.87）（112.03±7.04）（P<0.05），表明早期恢复体验更好。PNB组患者满意度更高（28/36对22/35，P<0.05）。
超声引导下PNB在疼痛控制和恢复质量方面比LAI更有效。它可被认为是PPH手术患者术后疼痛管理的有效方法。
本研究于2015年5月21日在中国临床试验注册中心（https://www.chictr.org.cn/，注册号：ChiCTR-IPR-15006427）注册。
