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Pre-emptive digitally guided pudendal block after posterior vaginal repair

INTRODUCTION AND HYPOTHESIS: The aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation. METHODS: We carried out a prospective, randomized, double-b...

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Autor principal: Uustal, Eva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346423/
https://www.ncbi.nlm.nih.gov/pubmed/32876714
http://dx.doi.org/10.1007/s00192-020-04488-x
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author Uustal, Eva
author_facet Uustal, Eva
author_sort Uustal, Eva
collection PubMed
description INTRODUCTION AND HYPOTHESIS: The aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation. METHODS: We carried out a prospective, randomized, double-blind trial in an outpatient surgery facility. Forty-one women between 18 and 70 years of age, scheduled for primary posterior vaginal reconstructive outpatient surgery, completed the study. The surgery was performed using sedation and local anesthesia with bupivacaine/adrenaline. At the end of surgery, 20 ml of either ropivacaine 7.5 mg/ml or sodium chloride (placebo) was administered as a digitally guided PDB. The primary aim was to establish if PDB with ropivacaine compared with placebo reduced the maximal pain as reported by visual analog scale (VAS) during the first 24 h after surgery. Secondary aims were to compare the duration and experience of the hospital stay, nausea, need for additional opioids, and adverse events. RESULTS: PDB with ropivacaine after local infiltration with bupivacaine/adrenaline after outpatient posterior repair did not significantly reduce maximal postoperative pain, need for hospital admittance, nausea, or opioid use. Mild transient sensory loss occurred after ropivacaine in two women. Two women the placebo group were unable to void owing to severe postoperative pain, which was resolved by a rescue PDB. CONCLUSIONS: When bupivacaine/adrenaline is used for anesthesia in posterior vaginal repair, PDB with ropivacaine gives no benefit regarding postoperative pain, recovery or length of hospital stay. Rescue PDB can be useful for postoperative pain relief.
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spelling pubmed-83464232021-08-20 Pre-emptive digitally guided pudendal block after posterior vaginal repair Uustal, Eva Int Urogynecol J Original Article INTRODUCTION AND HYPOTHESIS: The aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation. METHODS: We carried out a prospective, randomized, double-blind trial in an outpatient surgery facility. Forty-one women between 18 and 70 years of age, scheduled for primary posterior vaginal reconstructive outpatient surgery, completed the study. The surgery was performed using sedation and local anesthesia with bupivacaine/adrenaline. At the end of surgery, 20 ml of either ropivacaine 7.5 mg/ml or sodium chloride (placebo) was administered as a digitally guided PDB. The primary aim was to establish if PDB with ropivacaine compared with placebo reduced the maximal pain as reported by visual analog scale (VAS) during the first 24 h after surgery. Secondary aims were to compare the duration and experience of the hospital stay, nausea, need for additional opioids, and adverse events. RESULTS: PDB with ropivacaine after local infiltration with bupivacaine/adrenaline after outpatient posterior repair did not significantly reduce maximal postoperative pain, need for hospital admittance, nausea, or opioid use. Mild transient sensory loss occurred after ropivacaine in two women. Two women the placebo group were unable to void owing to severe postoperative pain, which was resolved by a rescue PDB. CONCLUSIONS: When bupivacaine/adrenaline is used for anesthesia in posterior vaginal repair, PDB with ropivacaine gives no benefit regarding postoperative pain, recovery or length of hospital stay. Rescue PDB can be useful for postoperative pain relief. Springer International Publishing 2020-09-02 2021 /pmc/articles/PMC8346423/ /pubmed/32876714 http://dx.doi.org/10.1007/s00192-020-04488-x Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Uustal, Eva
Pre-emptive digitally guided pudendal block after posterior vaginal repair
title Pre-emptive digitally guided pudendal block after posterior vaginal repair
title_full Pre-emptive digitally guided pudendal block after posterior vaginal repair
title_fullStr Pre-emptive digitally guided pudendal block after posterior vaginal repair
title_full_unstemmed Pre-emptive digitally guided pudendal block after posterior vaginal repair
title_short Pre-emptive digitally guided pudendal block after posterior vaginal repair
title_sort pre-emptive digitally guided pudendal block after posterior vaginal repair
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346423/
https://www.ncbi.nlm.nih.gov/pubmed/32876714
http://dx.doi.org/10.1007/s00192-020-04488-x
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