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The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review.
J Invest Surg. 2020 Jul 07 [Online ahead of print]JI

Abstract

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.

Authors+Show Affiliations

Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy. Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK. Department of Colorectal Surgery, Royal Marsden Hospital, London, UK. Department of Surgery and Cancer, Imperial College, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32633163

Citation

Fadel, Michael G., et al. "The Role of Pudendal Nerve Block in Colorectal Surgery: a Systematic Review." Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research, 2020, pp. 1-8.
Fadel MG, Peltola L, Pellino G, et al. The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review. J Invest Surg. 2020.
Fadel, M. G., Peltola, L., Pellino, G., Frunza, G., & Kontovounisios, C. (2020). The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review. Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research, 1-8. https://doi.org/10.1080/08941939.2020.1786611
Fadel MG, et al. The Role of Pudendal Nerve Block in Colorectal Surgery: a Systematic Review. J Invest Surg. 2020 Jul 7;1-8. PubMed PMID: 32633163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review. AU - Fadel,Michael G, AU - Peltola,Laura, AU - Pellino,Gianluca, AU - Frunza,Gabriela, AU - Kontovounisios,Christos, Y1 - 2020/07/07/ PY - 2020/7/8/entrez KW - colorectal surgery KW - local anesthesia KW - pain management KW - pudendal nerve block SP - 1 EP - 8 JF - Journal of investigative surgery : the official journal of the Academy of Surgical Research JO - J Invest Surg N2 - 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. SN - 1521-0553 UR - https://www.unboundmedicine.com/medline/citation/32633163/The_Role_of_Pudendal_Nerve_Block_in_Colorectal_Surgery:_A_Systematic Review L2 - http://www.tandfonline.com/doi/full/10.1080/08941939.2020.1786611 DB - PRIME DP - Unbound Medicine ER -
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