Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan–Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan–Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h () and during mobilization at 12, 24, 36, and 48 h () postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0–24 h () and during 24–48 h () postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, ). The patients in Group PNB had higher satisfaction compared to Group SA (). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan–Morgan hemorrhoidectomy.

中文翻译：

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超声引导下的阴部神经阻滞联合丙泊酚深度镇静与脊髓麻醉进行痔切除术：一项前瞻性随机研究

背景和目标。几种麻醉技术已用于痔切除术，但术后疼痛和尿retention留仍然是两个未解决的问题。这项前瞻性随机研究的目的是评估超声引导下的阴部神经阻滞（PNB）结合深度镇静与脊髓麻醉相比较在痔疮切除术中的效果。方法。120名接受Milligan–Morgan痔切除术的患者被随机分配接受丙泊酚（PNB组，n  = 60）或脊髓麻醉（SA组，n）进行深层镇静并联合PNB = 60）。使用视觉模拟量表评估疼痛强度（0：无疼痛至10：最严重的疼痛）。主要结局是在术后3、6、12、24、36和48 h休息时，步行12、24、36和48 h步行时记录的疼痛评分。次要结果是镇痛药的用量，副作用和术后患者的满意度。结果。超声引导下的双侧PNB结合丙泊酚深度镇静可以成功地应用于Milligan-Morgan痔疮切除术。在休息3、6、12、24、36和48 h时，PNB组的术后疼痛强度明显低于SA组（）以及在12、24、36和48小时动员期间（）。在0-24小时内，PNB组的舒芬太尼消耗量显着低于SA组（）和24-48小时（）。与SA组相比，PNB组的尿retention留率显着降低（6.9％对20％，）。与SA组相比，PNB组的患者满意度更高（）。 结论。超声引导下的PNB与丙泊酚镇静相结合是一种有效的麻醉技术，用于Milligan-Morgan痔疮切除术。