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Pudendal Nerve Block Techniques for Pain Control After Hemorrhoidectomy
Sponsor: Vinmec Healthcare System
Summary
Hemorrhoidectomy is frequently associated with severe postoperative pain despite multimodal analgesia. Ultrasound-guided pudendal nerve block has become an effective regional analgesic technique, but it remains unknown whether blockade performed proximally at the ischial spine provides superior analgesia compared with the more distal transperineal approach. The PINPOINT Trial is a prospective randomized assessor-blinded superiority trial comparing ultrasound-guided transgluteal (proximal) and transperineal (distal) pudendal nerve block in adults undergoing elective hemorrhoidectomy. The primary objective is to determine whether the proximal approach reduces cumulative opioid consumption during the first 48 postoperative hours. Secondary outcomes include pain intensity, opioid-related outcomes, recovery, complications, and patient-reported outcomes.
Official title: Transgluteal Versus Transperineal Pudendal Nerve Block for Analgesia After Hemorrhoidectomy: A Randomized Superiority Trial (The PINPOINT Trial)
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
140
Start Date
2026-09-15
Completion Date
2027-09-30
Last Updated
2026-09-10
Healthy Volunteers
No
Conditions
Interventions
Transgluteal Pudendal Nerve Block
Participants will receive bilateral ultrasound-guided posterior transgluteal pudendal nerve blocks under standardized general anesthesia. With the patient prone or in lateral decubitus, the gluteal region will be prepared aseptically. Ultrasound and color Doppler will identify the ischial spine, sacrospinous and sacrotuberous ligaments, and internal pudendal artery. An in-plane needle will be advanced into the interligamentous target plane, followed by injection of 5 mL ropivacaine 0.5% on each side. Local anesthetic spread will be assessed sonographically. Postoperative analgesia will include paracetamol and celecoxib when appropriate, with rescue opioids given for NRS pain \>3/10. Opioid consumption will be converted to morphine milligram equivalents (MME) for analysis.
Transperineal pudendal nerve block
Participants will receive bilateral ultrasound-guided transperineal pudendal nerve blocks following standardized general anesthesia. In lithotomy position, the perineum will be prepared aseptically. A high-frequency ultrasound probe will identify the relevant anatomical structures and the internal pudendal artery using Color Doppler. An echogenic needle will be advanced under ultrasound guidance into the ischioanal/ischiorectal fossa adjacent to the internal pudendal artery. After aspiration, 8 mL of 0.5% ropivacaine will be injected on each side, with ultrasound assessment of anesthetic spread. Postoperative analgesia will consist of standardized paracetamol and celecoxib. Rescue opioids will be administered for pain \>3/10 and converted to morphine milligram equivalents (MME) for analysis.