Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW)
Background: Inadequate management of acute post-haemorrhoidectomy pain is a major concern. Optimal pain management is necessary to reduce acute postoperative pain and improve care quality. Therefore, we investigated the efficacy of postoperative pudendal nerve block (PNB) in reducing acute post-haem...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Asian Journal of Surgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958424016439 |
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| author | Chang-Cyuan Chen Kuei-Ting Chang Yuan-Wen Lee Jian-Syun Chen Po-Li Wei Chia-Li Chang Yan-Jiun Huang |
| author_facet | Chang-Cyuan Chen Kuei-Ting Chang Yuan-Wen Lee Jian-Syun Chen Po-Li Wei Chia-Li Chang Yan-Jiun Huang |
| author_sort | Chang-Cyuan Chen |
| collection | DOAJ |
| description | Background: Inadequate management of acute post-haemorrhoidectomy pain is a major concern. Optimal pain management is necessary to reduce acute postoperative pain and improve care quality. Therefore, we investigated the efficacy of postoperative pudendal nerve block (PNB) in reducing acute post-haemorrhoidectomy pain in Asian individuals. Methods: This retrospective cohort study analysed 108 adult patients with grade 3 haemorrhoids. Patients with anorectal cancer were excluded from this study. Among the 108 patients, 79 and 29 received spinal anaesthesia (SA) with PNB (SAPNB) and SA alone, respectively. Propensity score matching and inverse probability of treatment weighting were performed to adjust for the effects of confounders. Results: Patients receiving SAPNB had significantly lower postoperative pain scores 6, 12, and 18 h after haemorrhoidectomy but significantly higher postoperative pain scores 24 and 48 h after haemorrhoidectomy than did patients receiving SA alone. PNB, older age, female sex, reduced operation time, and absence of cardiovascular disease reduced the risk of moderate to severe postoperative pain. Only the addition of PNB was consistently associated with a reduced risk of moderate to severe pain 6, 12, and 18 h after haemorrhoidectomy. Patients receiving SAPNB had significantly lower risks of perianal swelling and urinary retention but a significantly higher risk of nausea than did those receiving SA alone. The two groups exhibited similarity in their rates of postoperative readmission because of poor pain management and their lengths of stay upon readmission. Conclusion: The addition of PNB to SA may effectively reduce acute post-haemorrhoidectomy pain. |
| format | Article |
| id | doaj-art-e9c0a55ca86143aa83b191b6da76b4d3 |
| institution | Kabale University |
| issn | 1015-9584 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj-art-e9c0a55ca86143aa83b191b6da76b4d32024-12-28T05:21:15ZengElsevierAsian Journal of Surgery1015-95842025-01-01481131136Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW)Chang-Cyuan Chen0Kuei-Ting Chang1Yuan-Wen Lee2Jian-Syun Chen3Po-Li Wei4Chia-Li Chang5Yan-Jiun Huang6Department of Medical Education, Taipei Medical University Hospital, Taipei City, TaiwanDepartment of Medical Education, Chang Gung Memorial Hospital, Chiayi County, TaiwanDepartment of Anaesthesiology, Taipei Medical University Hospital, Taipei City, TaiwanDivision of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, TaiwanDepartment of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei City, TaiwanData Analyst, Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei City, TaiwanDepartment of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan; Corresponding author. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Xinyi District, Taipei City, 11031, Taiwan.Background: Inadequate management of acute post-haemorrhoidectomy pain is a major concern. Optimal pain management is necessary to reduce acute postoperative pain and improve care quality. Therefore, we investigated the efficacy of postoperative pudendal nerve block (PNB) in reducing acute post-haemorrhoidectomy pain in Asian individuals. Methods: This retrospective cohort study analysed 108 adult patients with grade 3 haemorrhoids. Patients with anorectal cancer were excluded from this study. Among the 108 patients, 79 and 29 received spinal anaesthesia (SA) with PNB (SAPNB) and SA alone, respectively. Propensity score matching and inverse probability of treatment weighting were performed to adjust for the effects of confounders. Results: Patients receiving SAPNB had significantly lower postoperative pain scores 6, 12, and 18 h after haemorrhoidectomy but significantly higher postoperative pain scores 24 and 48 h after haemorrhoidectomy than did patients receiving SA alone. PNB, older age, female sex, reduced operation time, and absence of cardiovascular disease reduced the risk of moderate to severe postoperative pain. Only the addition of PNB was consistently associated with a reduced risk of moderate to severe pain 6, 12, and 18 h after haemorrhoidectomy. Patients receiving SAPNB had significantly lower risks of perianal swelling and urinary retention but a significantly higher risk of nausea than did those receiving SA alone. The two groups exhibited similarity in their rates of postoperative readmission because of poor pain management and their lengths of stay upon readmission. Conclusion: The addition of PNB to SA may effectively reduce acute post-haemorrhoidectomy pain.http://www.sciencedirect.com/science/article/pii/S1015958424016439AnaesthesiaHaemorrhoidectomyInverse probability of treatment weightingPain managementPudendal nerve block |
| spellingShingle | Chang-Cyuan Chen Kuei-Ting Chang Yuan-Wen Lee Jian-Syun Chen Po-Li Wei Chia-Li Chang Yan-Jiun Huang Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) Asian Journal of Surgery Anaesthesia Haemorrhoidectomy Inverse probability of treatment weighting Pain management Pudendal nerve block |
| title | Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) |
| title_full | Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) |
| title_fullStr | Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) |
| title_full_unstemmed | Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) |
| title_short | Effectiveness of pudendal nerve block in the management of acute post-hemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW) |
| title_sort | effectiveness of pudendal nerve block in the management of acute post hemorrhoidectomy pain in asian individuals using inverse probability of treatment weighting iptw |
| topic | Anaesthesia Haemorrhoidectomy Inverse probability of treatment weighting Pain management Pudendal nerve block |
| url | http://www.sciencedirect.com/science/article/pii/S1015958424016439 |
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