Abstract
Objective:
Pudendal nerve blockade has been used for more than a century for obstetric analgesia. With the current opioid crisis, gynecologists recognize the importance of nonnarcotic alternatives for analgesia. This study assessed pudendal nerve blocking, using localization with electrical stimulation, during transvaginal reconstructive surgery, to manage postoperative pain.
Materials and Methods:
Subjects with pelvic organ prolapse (POP), undergoing transvaginal repair were enrolled in this pilot study. During each surgery a pudendal block was performed through the pararectal space using a stimulating electrical current to isolate the pudendal nerve via its motor action on the pelvic floor. Local anesthetic containing dexamethasone was injected bilaterally. Outcome measures assessed were total narcotic requirements, postoperative pain, and surgeon/patient satisfaction.
Results:
All subjects had advanced-stage POP. Ten received the block successfully, without complications. The mean time required to complete the block was 10 minutes. Only 2 subjects required 1 tablet each of hydrocodone–acetaminophen postoperatively. There were no postoperative complications. All subjects agreed that their pain management was satisfactory.
Conclusions:
Performing a pudendal block, using electrical stimulation during vaginal reconstructive surgery, could decrease patients' narcotic use significantly. This method is safe and efficacious, with excellent patient and surgeon acceptance. The information from this study will be used in pivotal research to test the efficacy of the method against a placebo.
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