A Comparative Prospective Study between Caudal Epidural and Pudendal Nerve Block as a Choice of Anesthesia and Post-Operative Pain Relief in Perineal Surgeries

Abstract

HAWRA NASSERALLA YASSER, NAWFAL ALMUBARAK

The regional anesthesia is well tolerated and reliable type of anesthesia in perineal surgery. Patients could be potentially benefited from nerve block by avoiding the complications of general anesthesia. Both Caudal and Pudendal nerve block are very applicable, safe, affordable and effective method, because both of them are much more less complications in comparison with other types of anesthesia like neuroaxial & GA. The aim of this comparative prospective study is to compare between Pudendal Nerve Block (PNB) and Caudal Epidural Block (CEB) as a choice of regional anesthetic technique in patients proposed for perineal surgeries (Anal surgeries, episiotomy and posterior vaginal wall repair).
Patients and Methods: This study was carried out in AlFaihaa Teaching Hospital in Basra-Iraq duration of study between the date of February to October 2019, included 70 patients in both genders; all cases are randomly allocated into two groups who underwent different perineal surgeries. The first group (A) received PNB (N=35), and second group (B) received CEB (N=35). The pain score was evaluated according to the visual analogue score from (0 to 10) ascending according to the pain severity.
Results: The age of patients included in this study was between 17-45 years old. There was no significant statistical association between the age and gender regarding the choice of RA approach, the heart rate and the mean arterial pressure (MAP) have no statistically significant but the pudendal nerve block showed significantly associated with less changes in blood pressure readings and to a lesser extent heart rate in comparison with caudal block. The patients who underwent pudendal nerve block had a significantly lower pain scores rather than caudal blockand P-value=0.03, which was lasting two hours postoperatively therefore P-value > 0.0001, which is highly significant.
Conclusion: In this observational comparative study that showed the Pudendal nerve block was more efficient for providing a good surgical anesthesia and post-operative pain relief than CEB based on Visual Analogue Score (VAS).