Pre-emptive analgesia by nerve stimulator guided pudendal nerve block for posterior colpoperineorrhaphy

Objective: To assess the effect of pre-emptive analgesia by bilateral nerve stimulator-guided pudendal nerve block (PNB) on pain intensity and consumption of analgesics following posterior colpoperineorrhaphy.

Study design: Prospective randomized observer-blinded study. The study included 130 patients who were scheduled to undergo posterior colpoperineorrhaphy under general anesthesia (GA). They were invited to enroll in the study during the period from October 2009 to August 2011 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 65 patients each: GA alone or GA combined with pre-emptive nerve stimulator-guided PNB with 10 mL of 0.25% bupivacaine in each side. The primary outcome measures were VAS pain scores and postoperative analgesic consumption.

Results: Postoperative average VAS pain scores, IM pethidine consumption and IV paracetamol consumption during the first 24 h; were highly significantly lower in the PNB group compared to the GA alone group. This technique was also associated with a significantly higher overall patient satisfaction compared to GA alone, without obvious side effects.

Conclusion: Pre-emptive analgesia by bilateral nerve stimulator-guided PNB is a simple and useful technique that when combined with GA was found to substantially reduce postoperative pain and consumption of analgesics during the first 24 h postoperatively, and shorten the time to return to normal activities compared to GA alone for patients undergoing posterior colpoperineorrhaphy. The use of PNB was also associated with a high overall patient satisfaction. Thus, the results of the present study may recommend the use of nerve stimulator-guided PNB in posterior colpoperineorrhaphy patients.