Application Of Ultrasound-guided Pudendal Nerve Block In Analgesia During Perineotomy

Objective:To study the analgesic effect of ultrasound-guided pudendal nerve block combined with epidural analgesia in pregnant women with episiotomy during the delivery compared with simple epidural analgesia.At the same time,the feasibility and advantages of ultrasound-guided pudendal nerve block was explored,so as to provide some reference for obstetric pain treatment.Method:A total of 62 primiparas who were natural parturient by vagina and singleton with cephalic presentation in the Third Affiliated Hospital of Nanchang University were selected from March 2018 to August 2018,which were randomly divided into experimental group(30 cases)and control group(32 cases).The control group adopted simple epidural analgesia,while the experimental group used ultrasound-guided pudendal nerve block combined with epidural analgesia.When the cervical orifice was completely opened in pregnant women of both groups,the patient-controlled epidural analgesia pump was closed.Episiotomy was performed by obstetricians or midwives with scissors,and a 5 cm incision was made at 45 degrees from the lower left perineum.Whether there was any difference and comparability in general information(age,height,BMI,gestational weeks,biparietal diameter)between the two groups.The VAS score of contraction pain before and after epidural block in the first stage of labor,the VAS score of lateral incision and stitching pain in the second stage of labor,and the number of additional patient-controlled analgesia as well as the number of additional local perineal anesthesia infiltration by midwives were analyzed and compared in the operation.At the same time,the intraoperative and postoperative complications were statistically analyzed in the two groups,and the satisfaction of labor analgesia mode was compared in the two groups.Result:1.There were no significant differences in age,gestational weeks,body mass index(BMI),height and biparietal diameter between the experimental group and the control group,with comparability(P > 0.05).2.There was no significant difference in VAS scores between the two groups before and after epidural block in the first stage of labor(P > 0.05).The VAS scores in the experimental group with lateral incision and stitching pain in the second stage of labor were lower than those in the control group,with statistical significance(P <0.05).However,the proportion of pregnant women in the experimental group with additional effective patient-controlled analgesia and local perineal anesthesia infiltration in the operation was much lower than that in the control group(P < 0.05).There was no significant difference in the second stage of labor,neonatal Apgar score of newborn and birth weight of newborn between the two groups(P > 0.05).3.In terms of complications,although there were 3 cases with bilateral lower limb weakness caused by simultaneous sacral plexus block and 9 cases with legs and feet numbness in the experimental group,all of which returned to normal within 24 hours without adverse sequelae of lower limb activities.they all recovered within 24 hours without any adverse sequelae involved in lower limb movement.Another pregnant woman had complications of uroschesis after operation,but timely indwelling catheter treatment,while no related complications were found in the control group,but in terms of satisfaction,the experimental group was still significantly higher than the control group(P < 0.05).Conclusion:Compared with simple epidural analgesia,ultrasound-guided pudendal nerve block combined with epidural analgesia not only utilizes the advantages of epidural analgesia,greatly reduces the pain in the first stage of labor,but also has a better analgesic effect in the second stage of labor,and reduces the discomfort of perineum in the second stage of labor.Although the ultrasound-guided pudendal nerve block technique in this study still has the risk of simultaneously blocking the sacral plexus nerve,it improves the satisfaction for the combined block method in pregnant women.This study shows that ultrasound-guided pudendal nerve block combined with epidural analgesia can further alleviate the pain of pregnant women during the delivery compared with simple epidural analgesia,providing a new choice for analgesia in pregnant women during the delivery.