Comparison between anesthetic approaches with pudendal nerve block on postoperative pain profile after anorectal surgery : our experience at King Hussein Medical Center

Abstract EN

Objective : To compare between different anesthetic methods with pudendal nerve block on postoperative pain quality after various anal surgical interventions.

Methods : Our prospective, randomized study included 114 patients, of both sexes, aged 20-55 years, classed I physical status by the American Society of Anesthesiologists (ASA) and assigned for multiple types of anorectal surgical procedures at King Hussein Hospital, King Hussein Medical Center, Amman-Jordan, during the period May-December 2012.

Subjects were divided randomly into 4 groups.

Group I patients (GI, n = 28) received subarachnoid block without pudendal nerve block, group II patients (GII, n = 29) received spinal block with pudendal block, group III patients (GIII, n = 28) received general anesthesia without pudendal block and group IV patients (GIV, n = 29) received general anesthesia with pudendal block.

Evaluation of postoperative pain profile during the first postoperative 48 hours included pain rating scale (verbal McGill pain questionnaire with no, mild, moderate and severe pain analgesic requirements and duration of analgesia.

P-value < 0.05 was considered as statistically significant.

Results : Severe pain incidence was 14.3 % in group I and 3.4 % in group II (P < 0.05) in the first postoperative 48 hours.

Severe pain was 17.9 % in group III and 6.9 % in group IV (P < 0.05) in the first postoperative 48 hours.

Mean duration of postoperative analgesia was 2.5 hours in group I and was 25.4 hours in group II(P < 0.05).Mean duration of postoperative analgesia was 0.5 hours in group III and was 19.5 hours in group IV(P < 0.05).

Conclusion : Postoperative pain relief after anorectal surgery can be prolonged if pudendal nerve block was added to general anesthesia or subarachnoid block.