The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review
Background Colorectal surgery is associated with significant pain often requiring opioid and non-opioid analgesics. Pudendal nerve blocks (PNBs) can be administered with the aim to reduce pain and improve patient satisfaction. However, there are no current accepted guidelines for the use of PNB in c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-11-01
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| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2020.1786611 |
| _version_ | 1797684518997458944 |
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| author | Michael G. Fadel Laura Peltola Gianluca Pellino Gabriela Frunza Christos Kontovounisios |
| author_facet | Michael G. Fadel Laura Peltola Gianluca Pellino Gabriela Frunza Christos Kontovounisios |
| author_sort | Michael G. Fadel |
| collection | DOAJ |
| description | Background Colorectal surgery is associated with significant pain often requiring opioid and non-opioid analgesics. Pudendal nerve blocks (PNBs) can be administered with the aim to reduce pain and improve patient satisfaction. However, there are no current accepted guidelines for the use of PNB in colorectal surgery. Method We evaluated the available literature on the role of PNB in colorectal surgery to determine which technique and anesthetic agent may provide optimal pain relief and safety. Studies from January 1970 to December 2019 assessing PNB in colorectal surgery were retrieved from MEDLINE and EMBASE databases. Indication for PNB, technique, anesthetic agent, postoperative pain outcomes, patient satisfaction and complications were extracted. Results We initially identified 339 studies of which 17 (nine randomized controlled trials, three cohort studies, one case-control study and four reviews) specifically met the inclusion criteria. The most common indication found for PNB is hemorrhoidectomy using either bupivacaine or lidocaine. The anatomical landmark and neurostimulation are the most favorable techniques being applied. The majority of studies reported better pain scores, less analgesia requirement and higher patient satisfaction when performing a bilateral PNB, with no major complications. Conclusions The current evidence, though limited, supports the use of bilateral PNBs in colorectal surgical procedures in particular hemorrhoidectomies. PNBs can be safe and effective in improving patient outcomes particularly when using bupivacaine or lidocaine with either the anatomical landmark or neurostimulation technique. |
| first_indexed | 2024-03-12T00:30:50Z |
| format | Article |
| id | doaj.art-124965924d414278a5fe542612c75230 |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:30:50Z |
| publishDate | 2021-11-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-124965924d414278a5fe542612c752302023-09-15T10:12:29ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532021-11-0134111238124510.1080/08941939.2020.17866111786611The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic ReviewMichael G. Fadel0Laura Peltola1Gianluca Pellino2Gabriela Frunza3Christos Kontovounisios4Department of Colorectal Surgery, Chelsea and Westminster HospitalDepartment of Anaesthesia, Chelsea and Westminster HospitalDepartment of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania “Luigi Vanvitelli"Department of Anaesthesia, Chelsea and Westminster HospitalDepartment of Colorectal Surgery, Chelsea and Westminster HospitalBackground Colorectal surgery is associated with significant pain often requiring opioid and non-opioid analgesics. Pudendal nerve blocks (PNBs) can be administered with the aim to reduce pain and improve patient satisfaction. However, there are no current accepted guidelines for the use of PNB in colorectal surgery. Method We evaluated the available literature on the role of PNB in colorectal surgery to determine which technique and anesthetic agent may provide optimal pain relief and safety. Studies from January 1970 to December 2019 assessing PNB in colorectal surgery were retrieved from MEDLINE and EMBASE databases. Indication for PNB, technique, anesthetic agent, postoperative pain outcomes, patient satisfaction and complications were extracted. Results We initially identified 339 studies of which 17 (nine randomized controlled trials, three cohort studies, one case-control study and four reviews) specifically met the inclusion criteria. The most common indication found for PNB is hemorrhoidectomy using either bupivacaine or lidocaine. The anatomical landmark and neurostimulation are the most favorable techniques being applied. The majority of studies reported better pain scores, less analgesia requirement and higher patient satisfaction when performing a bilateral PNB, with no major complications. Conclusions The current evidence, though limited, supports the use of bilateral PNBs in colorectal surgical procedures in particular hemorrhoidectomies. PNBs can be safe and effective in improving patient outcomes particularly when using bupivacaine or lidocaine with either the anatomical landmark or neurostimulation technique.http://dx.doi.org/10.1080/08941939.2020.1786611local anesthesiapudendal nerve blockcolorectal surgerypain management |
| spellingShingle | Michael G. Fadel Laura Peltola Gianluca Pellino Gabriela Frunza Christos Kontovounisios The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review Journal of Investigative Surgery local anesthesia pudendal nerve block colorectal surgery pain management |
| title | The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review |
| title_full | The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review |
| title_fullStr | The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review |
| title_full_unstemmed | The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review |
| title_short | The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review |
| title_sort | role of pudendal nerve block in colorectal surgery a systematic review |
| topic | local anesthesia pudendal nerve block colorectal surgery pain management |
| url | http://dx.doi.org/10.1080/08941939.2020.1786611 |
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