[Pudendal nerve block for perineo-vulvar surgery: monocentered prospective and randomised study]

Abstract

Objectives: Evaluation of pudendal nerve block on the quality of analgesia in perineal or vulvar surgery.

Patients and methods: We realised a monocentered, prospective and randomised study of all patients undergoing perineo-vulvar surgery. Two groups of patients were evaluated: general anaesthesia alone (GA group, 41 patients) and both general anaesthesia and bilateral nerve stimulator-guided pudendal nerve block (15 mL of Ropivacaïne 5 mg.mL(-1)+0,5 μg.kg(-1) of Clonidine) (PB group, 42 patients). Evaluation of pain was realised with per- and post-surgical prescription of hypnotics and antalgics was noted. The primary outcome measure was the Visual Analogic Scale (VAS) pain means scores in the first postoperative 24 hours.

Results: There was no difference in the VAS pain means scores in the first 24 hours, but it seemed to have a decrease in VAS pain at 2 hours in the PB group. Analgesic consumption during surgery was decreased in the same group. No complication of the pudendal block has been reported.

Discussion and conclusion: The nerve stimulator-guided pudendal nerve block is a simple and useful method which can, when associated with general anesthesia, reduce per-operative antalgics consumption and a decrease in the immediate postoperative pain in perineal or vulvar surgery, without complication or lengthening operating time. Further studies are needed to confirm the effectiveness of this technique and evaluate the costs and potential complications.

Keywords: Anesthésie multimodale; Bloc du nerf pudendal; Chirurgie périnéo-vulvaire; Multimodal anaesthesia; Neurostimulation; Perineo-vulvar surgery surgery; Pudendal nerve block.