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The Effect of Preemptive Pudendal Nerve Blockade on Pain After Transvaginal Pelvic Reconstructive Surgery

¹Division of Urogynecology, Evanston Continence Center, and ²Division of Anesthesia, Northwestern University Feinberg School of Medicine, Evanston, Illinois.

Address reprint requests to: Address correspondence to: Yoram Abramov, MD, Evanston Continence Center, Northwestern University, Feinberg School of Medicine, 1000 Central Street, Suite 730, Evanston, IL 60201; e-mail: y-abramov{at}northwestern.edu.

OBJECTIVE: To assess the effect of preemptive pudendal nerve blockade on pain and consumption of narcotic analgesia following transvaginal pelvic reconstructive surgery.

METHODS: This was a randomized, double-blind, placebo-controlled trial. Patients undergoing transvaginal pelvic reconstructive surgery under general anesthesia were randomized to receive pudendal block with either bupivacaine 0.25% or placebo (normal saline 0.9%) immediately before surgery. All patients received postoperative intravenous hydromorphone patient-controlled analgesia. Patients were asked to report on their pain intensity 1, 3, 5, 7, 18, and 24 hours postoperatively, using a validated visual analog pain scale from 0–10. Main outcome measures included postoperative pain intensity and hydromorphone consumption.

RESULTS: One hundred ten patients enrolled in the study, of whom 106 underwent randomization, and 102 received pudendal nerve blockade, 51 with bupivacaine and 51 with saline. Demographic and baseline clinical characteristics were not significantly different between the 2 patients groups. There were no significant differences in postoperative pain intensity (median scores: 1 hour, 4.0 versus 5.0; 3 hours, 3.0 versus 4.0; 7 hours, 2.0 versus 3.0; 18 hours, 3.0 versus 4.0), the consumption of hydromorphone (0–3 hours, 1.84 mg versus 1.77 mg; 4–7 hours, 1.19 mg versus 1.20 mg; 8–18 hours, 2.89 mg versus 2.35 mg), or mean hospital stay (39.6 versus 37.3 hours) between the bupivacaine and saline groups.

CONCLUSION: Preemptive pudendal nerve blockade does not affect postoperative pain intensity or the consumption of narcotic analgesia after transvaginal pelvic reconstructive surgery.

LEVEL OF EVIDENCE: I

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