Nerve stimulator–guided pudendal nerve block vs general anesthesia for postoperative pain management after anterior and posterior vaginal wall repair: a prospective randomized trial

Abstract Study objective Compare the effectiveness of nerve stimulator–guided pudendal nerve block (PNB) vs general anesthesia (GA) for anterior and posterior (AP) colporrhaphy in terms of pain relief and analgesic consumption within 24 and 48 hours postoperatively. Design Prospective randomized trial. Patients Fifty-seven patients whose ages ranged between 20 and 53 years scheduled to undergo AP colporrhaphy due to the presence of cystorectocele. Interventions Patients were randomly assigned into 2 groups receiving either nerve stimulator–guided PNB (n = 28) or GA (n = 29). A total volume of 0.7 mL/kg of the local anesthetic mixture was injected at 4 sites. Main results Both groups were similar with respect to age, weight, height, and surgery duration. There was a significant difference in average pain scores within the first and second postoperative days ( P values = .005 and .004, respectively). Total analgesic consumption (ketoprofen and tramadol) was significantly lower in the PNB within the first ( P values = .018 and .010) and second postoperative days ( P values = .041 and .011), respectively. Return to normal daily activity was significantly ( P < .0001) shorter in the PNB group compared with the GA group (3.6 days vs 12.2 days). A total of 71.4% of the patients in the PNB group were satisfied compared with 27.8% in the GA group ( P < .0001). Surgeon satisfaction was significantly higher in the PNB group (82.1% vs 34.5%, P < .0001). Conclusion This randomized controlled trial demonstrated that nerve stimulator–guided PNB could be used as an alternative to GA for AP repair of stages I and II prolapse because it is associated with less postoperative pain and analgesic consumption, in addition to shorter duration of recovery.