Pudendal nerve block versus usual lidocaine infiltration for pain relief in episiotomy repair: a comparative prospective study

ABSTRACT

Objective. We aimed to compare the anaesthetic and analgesic effect of the pudendal nerve block (PNB) and of the local lidocaine infiltration during episiotomy repair and in the following 24 hours.
Patients and Methods. 70 parturients undergoing natural birth requiring episiotomy and presenting contraindication or refusal of epidural analgesia were randomized to receive pudendal nerve block with ropivacaine or local lidocaine infiltration. The main endpoint was the evaluation of obstetric analgesia by visual analogical scale. The secondary judgment criteria were: haemodynamic parameters, suture duration, onset time of sensory block, time to first analgesic request, rehabilitation parameters, parturient and obstetrician satisfaction and pain intensifying factors.
Results. Mean VAS pain score was significantly lower in pudendal group versus infiltration group at T10 min (10 minutes after local anaesthetic injection) (7.20 ± 8.56 vs 20.43 ± 18.25, p < 0.01), T 15 min (5.43 ± 8.17 vs 17.71 ± 16.42, p < 0.01), T 20 min (repair starting) (29.63 ± 23.59 vs 44.06 ± 28.16, p = 0.023), T 1h (13.14 ± 19.18 vs 32.20 ± 21.25, p < 0.01), T 1h 30 min (10.57 ± 14.74 vs 27.34 ± 16.74, p < 0.01) and T 2h (9.57 ± 15.69 vs 25.34 ± 16.32, p < 0.01), T 6h (13.57 ± 14.07 vs 41.43 ± 23.24, p < 0.01), T 12h (22.60 ± 20.41 vs 36.49 ± 23.35, p = 0.010) and T 18h (12.23 ± 11.84 vs 27.94 ± 23.40, p < 0.01). Significantly shorter average suture time and better obstetrician’s satisfaction were observed in pudendal group. Nevertheless, parturient satisfaction did not reveal significant difference in our study, as well as time to first analgesic request.
Conclusions. Nerve stimulator guided PNB proved to be more effective for pain management in episiotomy repair than the classical lidocaine infiltration.