Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patient Selection Criteria
2.3. Variables and Definitions
2.4. Study Setting
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Postoperative Pain Outcomes
3.3. Postoperative Functional Outcomes
3.4. Early Complications, Surgery Duration, and Hospital Stay
4. Discussion
4.1. Pain Management
4.2. Functional Outcomes
4.3. Complications
4.4. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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PNB | SA | |
---|---|---|
Preoperative Period | ||
Admission | Day Surgery | Inpatient Admission |
Enema | None | None |
Fasting | None | 6 h Before Surgery |
Intraoperative Period | ||
Position | Lithotomy | Lithotomy |
Type of Anesthesia | Isolated Pudendal Block | Standard Spinal Anesthesia |
Surgical Procedure |
|
|
Surgeon | Same | Same |
Postoperative Period | ||
Postoperative follow up | Recovery Room | Inpatient Ward |
Oral Intake | Immediately | Postoperative 4th Hour |
Diagnosis | PNB (n: 435) | SA (n: 155) | Operation | PNB | SA | Total (n: 590) |
---|---|---|---|---|---|---|
Hemorrhoidal Disease (%) | 175 (72.6) | 66 (27.4) | Hemorrhoidectomy (%) | 25 (50) | 25 (50) | 50 |
LHP (%) | 133 (78.7) | 36 (21.3) | 169 | |||
Hemorrhoidopexy (%) | 5 (62.5) | 3 (37.5) | 8 | |||
Thrombectomy (%) | 12 (85.7) | 2 (14.3) | 14 | |||
Anal fistula (%) | 197 (77) | 59 (23) | Fistulotomy (%) | 115 (78.2) | 32 (21.8) | 147 |
Seton (%) | 76 (75.2) | 25 (24.8) | 101 | |||
LAFT (%) | 6 (75) | 2 (25) | 8 | |||
Anal fissure (%) | 28 (66.7) | 14 (33.3) | LIS (%) | 28 (66.7) | 14 (33.3) | 42 |
Anal wart (%) | 5 (55.6) | 4 (44.4) | Excision cauterization (%) | 5 (55.6) | 4 (44.4) | 9 |
Anal abscess (%) | 30 (71.4) | 12 (28.6) | Abscess drainage (%) | 30 (71.4) | 12 (28.6) | 42 |
Follow-up period/month (iqr) | 16 (10–23) | 14 (8–25) | 16 (9–23) |
PNB (iqr) | Intragroup pf | SA (iqr) | Intragroup pf | p† | ||
---|---|---|---|---|---|---|
HD | Hemorrhoidectomy | V0 = 4 (2–5) | V0-V1 > 0.999 | V0 = 4 (3–6) | V0-V1 = 0.472 | 0.317 |
npnb: 25, nsa: 25 | V1 = 3 (2–5) | V0-V2 < 0.001 | V1 = 5 (4–7) | V0-V2 < 0.001 | <0.001 | |
V2 = 1 (1–2) | V1-V2 = 0.003 | V2 = 2 (1–3) | V1-V2 < 0.001 | 0.023 | ||
LHP | V0 = 5 (6–2.5) | V0-V1 < 0.001 | V0 = 6 (3–7) | V0-V1 > 0.999 | 0.396 | |
npnb: 133, nsa: 36 | V1 = 3 (1–4) | V0-V2 < 0.001 | V1 = 5 (4–6) | V0-V2 = 0.033 | 0.002 | |
V2 = 2 (1–3) | V1-V2 = 0.023 | V2 = 1 (0–1) | V1-V2 = 0.069 | 0.010 | ||
Hemorrhoidopexy | V0 = 4 (3–7) | pf = 0.50 | V0 = 3 (3–4) | pf = 0.086 | >0.999 | |
npnb: 5, nsa: 3 | V1 = 2 (1–3) | V1 = 3 (3–4) | 0.071 | |||
V2 = 3 (1–3) | V2 = 1 (1–2) | 0.786 | ||||
Thrombectomy | V0 = 3.5 (2–5) | pf = 0.192 | V0 = 6 (5–7.5) | pf = 0.135 | 0.198 | |
npnb: 12, nsa: 2 | V1 = 3 (2–4) | V1 = 4 (4–5) | 0.132 | |||
V2 = 2 (1.25–3) | V2 = 1 (1–1.5) | 0.440 | ||||
FIA | Fistulotomy | V0 = 5 (1–6) | V0-V1 = 0.005 | V0 = 5 (1.5–6) | V0-V1 < 0.001 | 0.531 |
npnb: 115, nsa: 32 | V1 = 6 (5–7) | V0-V2 < 0.001 | V1 = 7 (6.25–9) | V0-V2 = 0.031 | <0.001 | |
V2 = 1 (1–2) | V1-V2 < 0.001 | V2 = 2 (1–2) | V1-V2 < 0.001 | 0.090 | ||
Seton | V0 = 5 (1–6) | V0-V1 = 0.056 | V0 = 5 (1–6) | V0-V1 > 0.999 | 0.753 | |
npnb: 76, nsa: 25 | V1 = 2 (2–3) | V0-V2 < 0.001 | V1 = 4 (4–5) | V0-V2 < 0.001 | <0.001 | |
V2 = 1 (1–2.75) | V1-V2 = 0.002 | V2 = 2 (1–3) | V1-V2 = 0.001 | 0.067 | ||
LAFT | V0 = 3 (0.75–5.75) | pf = 0.405 | V0 = 2 (2–5) | pf = 0.223 | 0.429 | |
npnb: 6, nsa: 2 | V1 = 2 (1–3.75) | V1 = 4 (4–4) | 0.286 | |||
V2 = 2 (0.75–2.5) | V2 = 1 (1–1.5) | 0.857 | ||||
AF | LIS | V0 = 4 (4–7) | V0-V1 > 0.999 | V0 = 4 (3.75–7) | V0-V1 > 0.999 | 0.955 |
npnb: 28, nsa: 14 | V1 = 4.5 (4–6.75) | V0-V2 < 0.001 | V1 = 6 (4.75–8.25) | V0-V2 = 0.014 | 0.045 | |
V2 = 1 (1–2) | V1-V2 < 0.001 | V2 = 1 (1–2) | V1-V2 = 0.001 | 0.966 | ||
AW | Excision cauterization | V0 = 5 (2.5–7.5) | V0-V1 = 0.618 | V0 = 3 (1.25–4.75) | V0-V1 = 0.102 | 0.315 |
npnb: 5 nsa: 4 | V1 = 7 (5.5–7.5) | V0-V2 = 0.618 | V1 = 8.5 (7.25–9) | V0-V2 > 0.999 | 0.059 | |
V2 = 3 (1–4.5) | V1-V2 = 0.034 | V2 = 3 (1.25–4) | V1-V2 = 0.102 | >0.999 | ||
PA | Abscess drainage | V0 = 7 (6–8) | V0-V1 = 0.002 | V0 = 6 (5.25–8) | V0-V1 > 0.999 | 0.314 |
npnb: 30, nsa: 12 | V1 = 4 (3–6) | V0-V2 < 0.001 | V1 = 6 (5.25–7.75) | V0-V2 = 0.002 | <0.001 | |
V2 = 1.5 (1–2.25) | V1-V2 = 0.005 | V2 = 2 (2–3) | V1-V2 < 0.001 | 0.129 |
PNB (iqr) | Intragroup p§ | SA (iqr) | Intragroup p§ | p† | ||||
---|---|---|---|---|---|---|---|---|
HH | Hemorrhoidectomy | D0 | 10.3 (5.4–21.8) | <0.001 | D0 | 12.6 (5.4–28.8) | 0.009 | 0.415 |
npnb: 25, nsa: 25 | D1 | 5.1 (2.6–14.6) | D1 | 13 (7.4–16.8) | 0.009 | |||
LHP | D0 | 11 (5–27.9) | <0.001 | D0 | 6.9 (2.9–31.3) | 0.413 | 0.403 | |
npnb: 133, nsa: 36 | D1 | 6 (2.4–14.4) | D1 | 10.2 (9.3–22.7) | 0.093 | |||
Hemorrhoidopexy | D0 | 11 (4.9–30.5) | 0.043 | D0 | 5.8 (4.1–20) | 0.109 | 0.571 | |
npnb: 5, nsa: 3 | D1 | 9.8 (3.1–18.8) | D1 | 8.1 (6.3–21.9) | 0.786 | |||
Thrombectomy | D0 | 14.6 (3.7–39.7) | 0.004 | D0 | 21.3–33.4 | 0.180 | 0.440 | |
npnb: 12, nsa: 2 | D1 | 7.5 (1.4–17.3) | D1 | 14.6–16.8 | 0.352 | |||
FIA | Fistulotomy | D0 | 13.5 (1.9–37.2) | <0.001 | D0 | 15.6 (3.6–38.5) | 0.018 | 0.400 |
npnb: 115, nsa: 32 | D1 | 9.3 (1.9–19.9) | D1 | 13.8 (4.2–23.6) | 0.047 | |||
Seton | D0 | 11.1 (4.3–25.6) | <0.001 | D0 | 15.6 (3.3–43.8) | 0.045 | 0.549 | |
npnb: 76, nsa: 25 | D1 | 5.7 (2.5–18.8) | D1 | 10.6 (5.5–27.2) | 0.029 | |||
LAFT | D0 | 6.6 (5.1–26.2) | 0.043 | D0 | 5.8–32.8 | 0.655 | >0.999 | |
npnb: 6, nsa: 2 | D1 | 3.1 (2.7–9.1) | D1 | 6.9–18.4 | 0.143 | |||
AF | LIS | D0 | 20.8 (20.8–32.8) | <0.001 | D0 | 21.1 (20.8–32.9) | 0.048 | 0.589 |
npnb: 28, nsa: 14 | D1 | 18.5 (14.7–21.8) | D1 | 23.3 (19.7–25.7) | 0.012 | |||
AS | Excision cauterization | D0 | 20.8 (10.4–30.7) | 0.080 | D0 | 19.9 (17.9–22.9) | 0.465 | 0.905 |
npnb: 5 nsa: 4 | D1 | 17.7 (5.5–24.5) | D1 | 16.3 (8.8–23.4) | 0.730 |
Bleeding | Urinary Retention | SSI | FI (Temporary or Permanent) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
PNB | SA | p | PNB | SA | p | PNB | SA | p | PNB | SA | p | |
Hemorrhoidectomy (%) | 3 (12) | 4 (16) | >0.999 | 0 (0) | 2 (8) | 0.490 | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - |
npnb: 25, nsa: 25 | ||||||||||||
LHP (%) | 2 (1.5) | 1 (2.8) | 0.515 | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - |
npnb: 133, nsa: 36 | ||||||||||||
Hemorrhoidopexy (%) | 0 (0) | 0 (0) | - | 0 (0) | 2 (66.7) | 0.107 | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - |
npnb: 5, nsa: 3 | ||||||||||||
Thrombectomy (%) | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - |
npnb: 12, nsa: 2 | ||||||||||||
Fistulotomy (%) | 5 (4.3) | 2 (6.3) | 0.646 | 1 (0.9) | 3 (9.4) | 0.032 | 2 (1.7) | 2 (6.3) | 0.207 | 4 (3.5) | 2 (6.3) | 0.611 |
npnb: 115, nsa: 32 | ||||||||||||
Seton (%) | 1 (1.3) | 1 (4) | 0.436 | 0 (0) | 3 (12) | 0.014 | 2 (2.6) | 2 (8) | 0.255 | 0 (0) | 0 (0) | - |
npnb: 76, nsa: 25 | ||||||||||||
LAFT (%) | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - | 0 (0) | 0 (0) | - |
npnb: 6, nsa: 2 | ||||||||||||
LIS (%) | 2 (7.1) | 1 (7.1) | >0.999 | 0 (0) | 2 (14.3) | 0.106 | 1 (3.6) | 1 (7.1) | >0.999 | 0 (0) | 1 (7.1) | 0.333 |
npnb: 28, nsa: 14 | ||||||||||||
Excision cauterization (%) | 0 (0) | 1 (25) | 0.444 | 0 (0) | 0 (0) | - | 1 (20) | 1 (25) | >0.999 | 0 (0) | 0 (0) | - |
npnb: 5 nsa: 4 | ||||||||||||
abscess drainage (%) | 1 (3.3) | 1 (8.3) | 0.495 | 1 (3.3) | 2 (16.7) | 0.192 | 1 (3.3) | 1 (8.3) | 0.495 | 0 (0) | 0 (0) | - |
Total (%) | 14 (3.2) | 11 (7.1) | 0.050 | 2 (0.5) | 14 (9) | <0.001 | 7 (1.6) | 7 (4.5) | 0.060 | 4 (0.9) | 3 (1.9) | 0.387 |
Pudental (±SD) | Spinal (±SD) | p § | ||
---|---|---|---|---|
Hemorrhoidectomy | OD/min | 27.8 (5.2) | 40.64 (6.1) | <0.001 |
HD/h | 1.7 (0.8) | 29.4 (8.9) | <0.001 | |
LHP | OD/min | 22.9 (4.9) | 42.3 (8) | <0.001 |
HD/h | 1.4 (0.6) | 28.6 (9.3) | <0.001 | |
LIS | OD/min | 15.6 (1.8) | 30.7 (1.9) | <0.001 |
HD/h | 1.6 (0.8) | 27.2 (6.5) | <0.001 | |
Seton | OD/min | 24.6 (5.9) | 41.2 (7.4) | <0.001 |
HD/h | 1.6 (0.8) | 27.7 (5.2) | <0.001 | |
Fistulotomy | OD/min | 19.8 (5.31) | 36.3 (4.6) | <0.001 |
HD/h | 1.6 (0.8) | 27.6 (5.1) | <0.001 |
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Şahin, S.; Yazkan, C.; Dere, Ö.; Kayılıoğlu, I.; Özcan, Ö. Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes. Medicina 2024, 60, 1651. https://doi.org/10.3390/medicina60101651
Şahin S, Yazkan C, Dere Ö, Kayılıoğlu I, Özcan Ö. Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes. Medicina. 2024; 60(10):1651. https://doi.org/10.3390/medicina60101651
Chicago/Turabian StyleŞahin, Samet, Cenk Yazkan, Özcan Dere, Ilgaz Kayılıoğlu, and Önder Özcan. 2024. "Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes" Medicina 60, no. 10: 1651. https://doi.org/10.3390/medicina60101651
APA StyleŞahin, S., Yazkan, C., Dere, Ö., Kayılıoğlu, I., & Özcan, Ö. (2024). Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes. Medicina, 60(10), 1651. https://doi.org/10.3390/medicina60101651