The Effect of Adjuvant Pudendal Nerve Block in Post-Operative Pain Following Perianal Surgery for Non Suppurative Conditions.

Background: Surgical management of non-suppurative perianal conditions are associated with intense pain in the postoperative period. Day case surgeries are often not possible for such conditions due to the need for post operative analgesia. The addition of pudendal nerve block lessens the post operative pain and hence avoids the need for opioids and its side effects. Aim: To assess the effectiveness of Pudendal nerve block in post -operative pain following perianal surgery for non suppurative conditions. Methods and material: Prospective cohort study. Patients undergoing surgical modality for anal fissures and hemorrhoids are divided into two groups. Group A receives pudendal nerve block (local infiltration) along with Spinal anaesthesia. Group B receives only Spinal anaesthesia. Post-operative pain (visual analog score) was analyzed and results compared. Results: It was found that there was a statistically significant association between being given pudendal nerve block and the need for analgesics post operatively. Conclusion: Pudendal block with local infiltration, if properly administered has excellent results with regard to patient’s pain tolerance, postoperative outcome and probable cost effectiveness. We conclude that the addition of pudendal nerve block with spinal anesthesia for non-suppurative anal conditions reduces the post operative pain and avoids the need for opioids and its side effects. It is safe and effective and it lessens the duration of hospital stay there by providing the patient with less stress of staying in the hospital for longer periods.

Laparoscopy in eosinophilic jejunitis presenting as subacute bowel obstruction: a case report.

Eosinophilic gastroenteritis is rare, seen in approximately 1 in 10,000 hospital admissions. The diagnosis is often retrospective and histopathological. Abdominal pain and obstructive symptoms associated with weight loss are the usual presenting complaints. We report a patient with symptoms of proximal bowel obstruction in whom diagnosis could not be made with conventional radiology and endoscopy. Laparoscopy showed that an intensely thickened proximal jejunum to be the cause of the obstruction. A laparotomy and resection anastomosis were done. The biopsy showed eosinophilic jejunitis. The patient did well post-operatively. The literature of this disease entity has been reviewed. Full-thickness laparoscopic biopsy and a course of steroids might avoid a laparotomy in these patients.