Analgesic effectiveness of pudendal nerve block for postoperative pain management in anorectal surgery- randomized controlled study

Anorectal surgeries often result in significant postoperative pain, which can impede recovery and necessitate high doses of opioid analgesics, leading to adverse effects. Effective pain management strategies are crucial to enhance patient comfort, expedite recovery, and reduce opioid consumption. Pudendal nerve block (PNB) targets the primary nerve supplying the anorectal region, potentially offering superior pain control. Despite its theoretical advantages, there is limited clinical evidence on its efficacy and safety in this context.  This study to evaluates the efficacy of pudendal nerve block (PNB) in managing postoperative pain following anorectal surgery. The research involved patients undergoing various anorectal procedures, who were randomly assigned to receive either a pudendal nerve block or a placebo. Aim of this study to assess the effectiveness of pudendal nerve block in post operative pain relief for anorectal surgeries. Primary Objective -To assess the Postoperative pain with the help of Visual analogue score at 0,3,6,12 and 24hrs. Secondary  Objectives: Requirement of rescue analgesic(total dose) and Total length of hospital stay.

Randomization will be done computer generated random number table all Patient will be divided in two groups.  Group A : Saddle block + Pudendal nerve block – 0.25% levobupivacaine 10ml/each side. Group B : (Control group) Saddle block – 0.5% bupivacaine heavy 1.5 ml.

Key findings indicated that patients who received the PNB reported significantly lower pain scores compared to the placebo group, particularly in the first 24 hours after surgery. Additionally, the PNB group required fewer opioid analgesics, demonstrating an overall reduction in postoperative opioid consumption. Secondary outcomes, including patient satisfaction and the requirement of rescue analgesic (total dose) and total length of hospital stay.

The study concludes that pudendal nerve block is a valuable technique in the multimodal approach to postoperative pain management for anorectal surgeries, offering better pain relief and reducing the need for opioid medications.