Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

This work was aimed to study the analgesic effect of pudendal nerve block on obstetrics and gynecology under the guidance of ultrasound image based on optimized fast super resolution reconstructed convolutional neural network (FSRCNN) algorithm. A total of 110 primiparas from hospital who gave birth through vagina were randomly rolled into experimental group (55 cases) and control group (55 cases). The optimized FSRCNN algorithm was constructed, compared with the FSRCNN algorithm and the Bicubic algorithm and applied to 110 cases of maternal patients undergoing perineotomy under ultrasound image-guided pudendal nerve block. Visual analogue scoring (VAS), incision suture pain VAS score, occurrence of complications, puerpera labor time, and newborn weight were recorded and compared, so did Apgar score of newborns, numbness of maternal thigh, recovery of puncture site, and satisfaction of maternal analgesia. The results showed that the peak signal-to-noise ratio (PSNR) of the high-resolution image reconstructed by the FSRCNN algorithm was 32.68 dB and that reconstructed by the optimized FSRCNN algorithm was 32.19 dB. The PSNR of the Bicubic algorithm processed image was 28.51 dB. In the lateral resection of episiotomy in the second stage of labor, the visual analog score (2.3 ± 1.5 points) of the experimental group was inferior to that of the control group (7.1 ± 2.6 points) ( P < 0.05 ). The visual analogue score of stitch pain (1.3 ± 0.8 points) was also inferior to that of the control group (5.2 ± 1.9 points) ( P < 0.05 ). Moreover, the satisfaction of the parturients in the experimental group (9.86 ± 0.41 points) was considerably superior to that of the control group (7.36 ± 1.25 points) ( P < 0.05 ). In short, the optimized FSRCNN algorithm had a short training time and good reconstruction effect. Ultrasound-guided pudendal nerve block had a substantial analgesic effect on the second stage of labor and improved parturients’ satisfaction.

Effect of Pudendal Nerve Block versus Perineal Local Infiltration of Analgesia In Post Episiotomy Pain Relief A randomized Controlled Clinical Trial

Background Episiotomy or tearing of perineal tissues during childbirth is associated with significant pain in the postpartum period. Although the use of episiotomy is often debated, it remains the most common surgical procedure experienced by women. Pain from episiotomy is poorly treated, though it may be severe and can result in significant discomfort and interference with basic daily activities and adversely impact motherhood experiences. Local infiltration analgesia is the most commonly used method of analgesia during normal labor. This type of local analgesia is achieved by injecting the analgesic agent into the perineum just before delivery with crowning of the fetal head. It is also widely used just before an episiotomy. This study compares the efficacy and duration of pudendal nerve block versus local infiltration on post episiotomy pain relief. Aim of the Work: This study aims to compare the effect of Pudendal Nerve Block with perineal local infiltration of analgesia in post episiotomy pain relief. Study design:Prospectiverandomizedcontrolledclinicaltrial. Patients & Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2018 and Jan 2019. It included 100 primigravida women in labor meeting inclusion criteria attending the causality of Ain Shams Maternity Hospital. Results Our study showed statistically significant decrease mean of study group compared to control group according VAS score from after 1hr to after 6hrs. Also there was statistically significant decrease in patients' need for analgesia in study group compared to control group from after 1hr to after 6hrs. Patients were asked about episiotomy pain and were advised not to be distracted by pain of uterine contraction or any other pain she complains of as much as possible not to alter the study results Regarding the pudendal nerve block group none of the patients receiving effective bilateral pudendal nerve block asked for analgesia during the first hour post injection. Two patients representing 4.4% of the study group asked for analgesia after two hours post injection, by the 3rd hour 6 patients representing 13.3% of the study group asked for analgesia. After completing 6 hours post injection follow up only 21 patients asked for analgesia representing 46.7% of the study group while 24 patients (53.3%) did not require any analgesia for the first 6 hours after injection of pudendal nerve block Conclusion There is statistically significant decrease in mean VAS in pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. Also there is statistically significant decrease in patients' need for analgesia in case of pudendal nerve block compared to local perineal infiltration of analgesia from after 1hr to after 6hrs of injection. There is highly statistically significant increase mean of delivery time after injection (min) in pudendal nerve block compared to local perineal infiltration of analgesia but it has no clinical significance. There are no neonatal side effects or complications of pudendal nerve block.

Comparative study between ultrasound-guided pudendal nerve block and caudal epidural block anesthesia in children undergoing hypospadias surgery

Background The aim of the study is to compare the effectiveness and safety of ultrasound-guided pudendal nerve block versus caudal epidural block as a part of multimodal analgesia in children undergoing hypospadias surgery. In this prospective, single-blinded study, 50 patients were randomized into 2 groups (25 each group) either receiving ultrasound-guided pudendal nerve block group A or caudal epidural block group B. In the pudendal nerve block group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the caudal epidural group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. Consumption of paracetamol was assessed during the first 24 h postoperatively. The “objective pain scale” done by Hannalah and Broadman was used to assess postoperative pain. Results This prospective randomized controlled single-blind clinical study was performed on total (50) ASA status I or II patients, of age 3 to 6 years scheduled for hypospadias surgery. For the primary outcome, there was no statistically significant difference found between the two studied groups regarding objective pain score at arrival to PACU with p value = 1.000 while there was a statistically significant increase in pain score in group B than group A at 6 h and 12 h with p value = 0.017 and 0.003, respectively. Also, no statistically significant difference found between the two groups after 18 h with p value = 0.238 may be due to receiving acetaminophen dose in group B. Finally there was a statistically significant increase found in objective pain score in group B at 24 h than group A with p value = 0.015. And there was a statistically significant increase in time to first analgesia in group A than group B with p value < 0.001 while there was a statistically significant increase in total dose of acetaminophen in group B than group A with p value < 0.001. Conclusion Both ultrasound-guided pudendal block and caudal epidural block are effective and safe methods for postoperative analgesia for children undergoing hypospadias surgery but ultrasound-guided pudendal block gives more postoperative pain control.

Pudendal nerve block in hemorrhoid surgery: A systematic review and meta-analysis

Objective Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, in particular in a surgical day care setting. The aim of this study was to investigate the use of pudendal nerve block (PNB) in patients undergoing hemorrhoidectomy. Methods PubMed, Google Scholar, Cochrane Library and Web of Science databases were searched up to December 2020. Randomized trials evaluating the PNB use on postoperative outcomes in patients undergoing hemorrhoidectomy were selected. Opioid consumption, pain on the visual analogue scale, length of hospital stay and readmission rate were the main outcomes of interest and were plotted by using a random-effect model. Results The literature search revealed 749 articles, of which 14 with were deemed eligible. A total of 1,214 patients was included, of whom 565 received the PNB and 649 did not. After hemorrhoidectomy, patients in the PNB group received opioids less frequently (RR 0.364, 95%CI 0.292 to 0.454, p &lt; 0.001) and in a lower cumulative dose (SMD -0.935, 95%CI -1.280 to -0.591, p &lt; 0.001). Patients receiving PNB experienced less pain at 24 hours (SMD -1.862, 95%CI -2.495 to -1.228, p &lt; 0.001), had a shorter length of hospital stay (SMD -0.742, 95%CI -1.145 to -0.338, p &lt; 0.001) and a lower readmission rate (RR 0.239, 95%CI 0.062 to 0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary endpoint and the overall evidence quality was judged “high”. Conclusion This systematic review and meta-analysis shows significant advantages of the PNB use. A reduction in opioid consumption, postoperative pain, complications and length of stay can be demonstrated. Despite limitations, PNB in patients undergoing hemorrhoidectomy should be taken into account.