Pudendal Block Research Articles

Comparison of the Analgesic Efficacy of Ultrasound-Guided Transperineal Approach Using Pudendal Nerve Block Versus Caudal Block in Children Undergoing Urological Surgeries: A Randomized Controlled Trial.

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 Systemgrade 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 blockprovides longer-lasting analgesia, lower pain scores, andfaster readiness for discharge though with a similar analgesic consumption compared to caudal block. These resultsindicate the potential of ultrasound-guided pudendal nerve blocks as a beneficial and safe alternative to caudal block for perineal procedures in children.

Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial

Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial

US-guided pudendal nerve block as sole anesthetic technique in hemorrhoidectomy: our experience.

US-guided pudendal nerve block as sole anesthetic technique in hemorrhoidectomy: our experience.

The effect of combined pudendal nerve and spermatic cord block or caudal epidural block on postoperative analgesia after posterior urethroplasty: a randomized trial

BackgroundPostoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB).MethodsSixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively.ResultsTwo patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB.ConclusionsPN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB.Trial registrationThis study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).

Cadaver study of ultrasound-guided pudendal nerve block in six horses

Cadaver study of ultrasound-guided pudendal nerve block in six horses

Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better "Rescue Programming" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.

Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long-term follow-up. This review aimed to describe current strategies and future directions in patients undergoing such therapies. This is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence - Research Society (ICI-RS), June 6-8, 2024 (Bristol, UK): "Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better 'rescue programming' in SNM and PTNS, and lost opportunities for new sites of stimulation?" Rescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long-term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high-frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women. The exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.

Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes.

Background and Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

The Impact of Pudendal Nerve Injection in Vaginal Surgery: A Secondary Analysis

Importance Evidence regarding the effect of pudendal nerve blockade during vaginal surgery is conflicting. Previous studies compared pudendal nerve blockade to either normal saline placebo injection or no injection, demonstrating small or no difference in pain outcomes. Studies investigating nerve blocks at the time of vaginal surgery have not evaluated the effect of infiltration of the space around the pudendal nerve. Objective The aim of the study was to determine whether intraoperative pudendal nerve injection (bupivacaine or normal saline) will result in improved pain scores and satisfaction compared with patients who receive no pudendal injection. Study Design We performed a secondary analysis of 2 randomized controlled trials investigating postoperative pain after vaginal reconstructive surgery, comparing the outcomes of the following 3 groups: control (no pudendal injection), intervention (bilateral pudendal nerve blockade), and placebo (bilateral normal saline pudendal injections). The primary outcome was postoperative pain scores. Secondary outcomes were opioid use, patient satisfaction, and postoperative complications. Linear mixed effects models were applied to outcomes, and treatment effects with 95% confidence intervals were estimated at each time point from the model. Results One hundred four patients who underwent vaginal surgery were included: 36 pudendal nerve block, 35 normal saline pudendal injection, and 33 no injection. The groups were well-matched. Linear mixed effects models demonstrated no significant differences between treatment groups for postoperative pain severity scores, opioid use, and patient-reported satisfaction at each time point. Conclusions Normal saline injection and no injection seem to have no clinically meaningful difference in effect, and either could reasonably serve as control for pudendal blockade during vaginal surgery.

Cell-type specific methylation changes in the newborn child associated to obstetric pain relief

Although it is widely known that various pharmaceuticals affect the methylome, the knowledge of the effects from anesthesia is limited, and nearly nonexistent regarding the effects of obstetric anesthesia on the newborn child. Using sequencing based-methylation data and a reference-based statistical deconvolution approach we performed methylome-wide association studies (MWAS) of neonatal whole blood, and for each cell-type specifically, to detect methylation variations that are associated with the pain relief administered to the mother during delivery. Significant findings were replicated in a different dataset and followed-up with gene ontology analysis to pinpoint biological functions of potential relevance to these neonatal methylation alterations. The MWAS analyses detected methylome-wide significant (q&lt;0.1) alterations in the newborn for laughing gas in granulocytes (two CpGs, p&lt;5.50x10-9, q = 0.067), and for pudendal block in monocytes (five CpGs across three loci, p&lt;1.51 x10-8, q = 0.073). Suggestively significant findings (p&lt;1.00x10-6) were detected for both treatments for bulk and all cell-types, and replication analyses showed consistent significant enrichment (odds ratios ranging 3.47–39.02; p&lt;4.00×10−4) for each treatment, suggesting our results are robust. In contrast, we did not observe any overlap across treatments, suggesting that the treatments are associated with different alterations of the neonatal blood methylome. Gene ontology analyses of the replicating suggestively significant results indicated functions related to, for example, cell differentiation, intracellular membrane-bound organelles and calcium transport. In conclusion, for the first time, we investigated and detected effect of obstetric pain-relief on the blood methylome in the newborn child. The observed differences suggest that anesthetic treatment, such as laughing gas or pudendal block, may alter the neonatal methylome in a cell-type specific manner. Some of the observed alterations are part of gene ontology terms that previously have been suggested in relation to anesthetic treatment, supporting its potential role also in obstetric anesthesia.

Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial.

The utility of pudendal nerve blocks (PNBs) at the time of transvaginal surgery is mixed in the literature. No published study has evaluated the efficacy of PNB since the widespread adoption of Enhanced Recovery After Surgery (ERAS) pathways. This study aimed to determine if PNB, in addition to ERAS measures, at the time of vaginal reconstructive surgery reduces opioid use in the immediate postoperative period. In this randomized, blinded, controlled trial, women scheduled for transvaginal multicompartment prolapse repair were randomized to bilateral PNB before incision with 20 mL of 0.5% bupivacaine versus usual care. Primary outcome was opioid use in morphine milligram equivalents (MME) for the first 24 hours. The study was powered to detect a 5.57-MME difference in opioid use in the first 24 hours between groups. Forty-four patients were randomized from January 2020 to April 2022. The PNB and control groups were well matched in demographic and surgical data. There was no difference in opioid use in first 24 hours between the control and PNB groups (8 [0-20] vs 6.7 [0-15]; P = 0.8). Median pain scores at 24 and 48 hours did not differ between groups (4 ± 2 vs 3 ± 3; P = 0.44) and 90% of participants were satisfied with pain control across both groups. Time to return to normal activities (median, 10 days) was also not different between the groups. Because pain satisfaction after transvaginal surgery in the era of ERAS is high, with overall low opioid requirements, PNB provides no additional benefit.

Endovascular stimulation of the pudendal nerve using a stent-mounted electrode array

Objective. Previous preclinical and clinical studies have demonstrated that pudendal nerve is a promising target for restoring bladder control. The spatial proximity between the pudendal nerve and its accompanying blood vessels in the pudendal canal provides an opportunity for endovascular neurostimulation, which is a less invasive approach compared to conventional chronically implanted electrodes. In this study, we investigated the feasibility of excitatory stimulation and kilohertz-frequency block of the compound pudendal nerve in sheep using a stent-mounted electrode array.Approach. In a set of acute animal experiments, a commercially available hexapolar electrode catheter was introduced in the unilateral internal pudendal artery to deliver bipolar electrical stimulation of the adjacent compound pudendal nerve. The catheter electrode was replaced with a custom-made stent-mounted electrode array and the stimulation sessions were repeated. Global electromyogram activity of the pelvic floor and related sphincter muscles was recorded with a monopolar electrode placed within the urethra concurrently.Main results. We demonstrated the feasibility of endovascular stimulation of the pudendal nerve with both electrode types. The threshold current of endovascular stimulation was influenced by electrode-nerve distance and electrode orientation. Increasing the axial inter-electrode distance significantly decreased threshold current. Endovascular kilohertz-frequency nerve block was possible with the electrode catheter.Significance. The present study demonstrated that endovascular stimulation of the pudendal nerve with the stent-mounted electrode array may be a promising less invasive alternative to conventional implantable electrodes, which has important clinical implications in the treatment of urinary incontinence. Endovascular blocking of pudendal nerve may provide an alternative solution to the bladder-sphincter dyssynergia problem in bladder management for people with spinal cord injury.

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

BackgroundThere is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic–pituitary axis. Published studies note that doses...

Comparing the Efficacy of US Guided Pudendal Nerve Block plus Periprostatic Nerve Block versus Periprostatic Nerve Block Alone for Pain Control of Patients During and After Transrectal Biopsy of the Prostate Gland

Abstract Background Cancer prostate is considered one of the most common cancers among male population. Trans rectal ultrasound (TRUS) guided biopsy has become the main procedure for diagnosing prostate carcinoma, In order to definitively diagnose prostate carcinoma, (TRUS)-guided prostate biopsy is needed. Aim of the Work To compare the efficacy, safety of Pudendal nerve block plus periprostatic nerve block with the standard technique (periprostatic nerve block). Patients and Methods during a period of 6 months duration A total of 30 patients (group 1 [Pedundal nerve block plus periprostatic nerve block], n = 15; group 2 [periprostatic nerve block], n = 15) were included in the study. all patients were instructed about how to assess pain and discomfort level using a visual analog scale (VAS) from 0 to 10, with an 11-point score (0 = no pain, 10 = intolerable pain). Results in our study 30 male patients were divided into 2 groups, group 1 underwent to (PPNB) and group 2 (PPNB + pudendal block). The mean age of the studied group was 58.8 ± 10 years old. All patients hadn’t previous history for prostate surgery nor for rectoanal disease. In our study we evaluated pain scores immediately after the procedure. Regarding the relation between VAS and two studied group, there was an increase in VAS in group 1 more than group 2 along the three sets of follow up with statistical difference between two studied groups in all follow ups as p-Value was &amp;lt;0.05. Conclusion our data suggest that combined bilateral pudendal nerve block plus periprostatic nerve block is more effective than periprostatic nerve block alone in reducing the pain during TRUS guided prostate biopsy.

Ultrasound-Guided Pudendal Nerve Block versus Caudal Block for Post-Operative Analgesia in Penile Surgeries in Children

Abstract Background Penile surgeries as hypospadias, urethroplasty and circumcision are of the most frequently performed surgical procedures in the pediatric male population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. This study was to compare the effectiveness and safety of ultrasound (US) guided pudendal nerve block (PNB) versus caudal block (CB) for postoperative analgesia in pediatric male patients undergoing penile surgeries. Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups (20 each group) either receiving ultrasound-guided pudendal nerve block (PNB group) or caudal epidural block (CB group). In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. The two groups were adequately monitored and assessed pre, intra and post-operatively and they were compared regarding demographic data, pre, intra and postoperative hemodynamics, postoperative pain control using objective pain scale (OPS) score, consumption of paracetamol in the 1st 24 hours postoperatively and complications of both anesthetic techniques. Results This prospective randomized controlled single-blind clinical study was performed on total 40 patients of age 3 to 10 years scheduled for penile surgeries. For the primary outcome, there was a statistically significant increase in time to first analgesia in PNB group than CB group with p value &amp;lt; 0.001 while there was a statistically significant increase in total dose of paracetamol in CB group than PNB group with p value &amp;lt; 0.001. For OPS score, there was a statistically significant increase in pain score in CB group than PNB group at 6 h, 12 h and 24 h with p value = 0.02, 0.005 and 0.01, respectively. Conclusion From our study we can conclude that US guided PNB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in pediatric patients undergoing penile surgeries and also demonstrated that both analgesic techniques are safe.

Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study.

Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block (SESPB) and pudendal nerve block (PNB) in reducing the incidence and score of CRBD. Methods: This study was conducted between November and December 2023. ASA I-III, fifty-four TURP patients were divided into two groups: Group 1 received SESPB (n = 27) and Group 2 received PNB (n = 27) under ultrasound guidance at the end of surgery. The incidence of CRBD, CRBD score, numerical rating scale (NRS) score, use of rescue analgesics, block performance time, first call for analgesics, patient satisfaction, and side effects were recorded for 24 h. Results: The incidence of CRBD was lowest at 33.3% and highest at 48.1% in Group 1 and lowest at 25.9% and highest at 48.1% in Group 2, with no significant difference between the groups at all measurement times. CRBD scores and NRS scores were low and similar between the two groups. Block performance times were 9 ± 1.7 min in SESPB and 20 ± 2.5 min in PNB, and there was a significant difference between the mean times (p < 0.001). Patient satisfaction was adequate and similar in both groups. Conclusions: SESPB demonstrated a similar decreasing effect to PNB on the incidence and scores of CRBD in the first 24 h following TURP operations. The duration of SESPB administration was shorter than PNB.

(083) CHRONIC VULVAR PAIN AND URINARY DISTURBANCES REVEALING A LARGE TARLOV CYST IN A 41-YEAR-OLD WOMAN: A CASE REPORT

Abstract Introduction Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled nerve root cysts predominantly located at the sacral spine. While typically asymptomatic, large Tarlov cysts may elicit discomforting symptoms. Diagnostic challenges stem from limited understanding and symptom overlap with various disorders. Objective This case report explores the presentation of a 41-year-old female patient exhibiting symptoms of vulvar pain and urinary disturbances, which were ultimately attributed to a large Tarlov cyst, highlighting the complexities of diagnosis and management associated with this condition. Methods A 41-year-old female patient with a past medical history of linear scleroderma, chronic left hip pain with leg length discrepancy, and family history of endometriosis presented to her primary care physician with vulvar pain and urinary symptoms. She had burning vulvar pain, predominantly on the left side, radiating from the vulvar vestibule to the perineum, which gradually worsened over 6 months. She also had lower back pain radiating into her legs and calves, along with increased urinary frequency, urgency, retention and burning upon micturition. Patient underwent a 11-month treatment regimen following a referral to pelvic pain specialist, including being initiated on gabapentin and vaginal suppositories, which provided significant pain relief. However, over time, her vulvar pain gradually worsened, and gabapentin was replaced with pregabalin. She underwent six weeks of pelvic floor physical therapy and received a series of peripheral nerve blocks, including multiple pudendal nerve blocks, trigger point injections and hydrodissection of connective tissue around the nerves, yielding little pain relief. Due to persistent vulvar pain, the patient was referred to our clinic. Her examination revealed tenderness upon palpation over the lumbar-sacral spine and sacroiliac joint and para-spinal muscle spasm on the left side. She had provoked vestibulodynia that was predominately on the posterior aspect of the vestibule with a Q-tip test 8/10, and about 4/10 at anterior vestibule. She also continued to have tenderness in her pelvic floor muscles. Given her history and physical exam, a spinal pathology was suspected, and lumbosacral MRI was ordered. Results The lumbosacral MRI revealed a Tarlov cyst measuring 7.7 cm x 3.9 cm x 4.2 cm, extending from the L5-S1 disc level to the S3-S4 vertebral body junction. The patient was subsequently referred to a neurosurgeon who performed a twelve-hour surgery, including a dissection of the intrasacral meningeal cyst that was causing sacral nerve root compression and subsequent wrapping of the weakened right S2-S3 nerve roots. Postoperatively, the pain, although decreased, persisted due to nerve root thinning and long-term compression of the sacral nerve roots. She is currently being managed by our clinic, pain specialists and rehabilitation. A two-year recovery period is anticipated. Conclusions This case underscores the diagnostic challenge of vulvar pain in the context of a Tarlov cyst and emphasizes the necessity for heightened clinical suspicion and comprehensive evaluation. Additionally, the case highlights the importance of considering MRI of the lumbosacral spine as an early investigation in patients presenting with otherwise unexplained chronic vulvar pain, offering a valuable diagnostic tool for identifying conditions like Tarlov cysts that might otherwise remain elusive. Disclosure No.

Pudendal nerve block versus usual lidocaine infiltration for pain relief in episiotomy repair: a comparative prospective study

Pudendal nerve block versus usual lidocaine infiltration for pain relief in episiotomy repair: a comparative prospective study

Pudendal nerve block decreases narcotic requirements and time spent in post-anesthesia care units in patients undergoing primary inflatable penile prosthesis implantation.

Efforts to minimize narcotic usage following inflatable penile prosthesis (IPP) implantation are vital, considering the current opioid epidemic in the United States. We aimed to determine whether pudendal nerve block (PNB) utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. A single-institution, retrospective study was conducted on patients who underwent primary IPP implantation between December 2015 and June 2022. PNB usage and intra- and post-operative outcomes were analyzed using multivariate binary logistic regression. 449 patients were included, with 373 (83.1%) in the PNB group. Median time (minutes) spent in the post-anesthesia care unit (PACU) (1499 [119-198] vs. 235 [169-322], p < 0.001) was significantly lower in the PNB group. There were no significant differences in intra-operative and PACU morphine milligram equivalents or post-operative safety outcomes between groups. However, fewer patients in the PNB group called for pain medications post-operatively (10.2% vs 19.7%, p = 0.019). Multivariate analysis revealed a significantly decreased operative time (B -6.23; 95%CI -11.28, -1.17; p = 0.016) and decreased time in recovery (B: -81.62; 95%CI: -106.49, -56.76, p < 0.001) in the PNB group. PNB decreases post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation and thus may represent an attractive, non-opioid adjunct.

Efficacy of ganglion impar block combined with pudendal nerve pulsed radiofrequency for pudendal neuralgia management—a randomized clinical trial

BackgroundPudendal neuralgia is a chronic and debilitating condition. Its prevalence ranges from 5 to 26%. Currently, therapeutic approaches to treat pudendal neuralgia include patient education, medication management, psychological and physical therapy, and procedural interventions, such as nerve block, trigger point injections, and surgery. Drug therapy has a limited effect on pain relief. A pudendal nerve block may cause a significant decrease in pain scores for a short time; however, its efficacy significantly decreases over time. In contrast, pudendal nerve pulsed radiofrequency can provide pain relief for 3 months, and ganglion impar block has been widely used for treating chronic perineal pain and chronic coccygodynia. This study aimed to determine the efficacy and safety of monotherapy (pudendal nerve pulsed radiofrequency) and combination therapy (pudendal nerve pulsed radiofrequency plus ganglion impar block) in patients with pudendal neuralgia.MethodsThis randomized, controlled clinical trial will include 84 patients with pudendal neuralgia who failed to respond to drug or physical therapy. Patients will be randomly assigned into one of the two groups: mono or combined treatment groups. The primary outcome will be a change in pain intensity measured using the visual analog scale. The secondary outcomes will include a Self-Rating Anxiety Scale score, Self-Rating Depression Scale score, the use of oral analgesics, the Medical Outcomes Study Health Survey Short Form-36 Item score, and the occurrence of adverse effects. The study results will be analyzed using intention-to-treat and per-protocol analyses. Primary and secondary outcomes will be evaluated between the mono and combined treatment groups. Subgroup analyses will be conducted based on the initial ailment, age, and baseline pain intensity. The safety of the treatment will be assessed by monitoring adverse events, which will be compared between the two groups.DiscussionThis study protocol describes a randomized, controlled clinical trial to determine the efficacy and safety of mono and combination therapies in patients with pudendal neuralgia. The study results will provide valuable information on the potential benefits of this combination therapy and contribute to the development of more effective and safer treatments for patients with pudendal neuralgia.Trial registrationChinese Clinical Trial Registry (ChiCTR2200061800).

Ultrasound-Guided Pudendal Nerve Block for Intra and Postoperative Pain Management in Pediatric Penoscrotal Surgery

Ultrasound-Guided Pudendal Nerve Block for Intra and Postoperative Pain Management in Pediatric Penoscrotal Surgery