Efficacy evaluation of radiofrequency thermocoagulation and pulse radiofrequency for the ganglion impar in treating primary perineal pain / 西安交通大学学报(医学版)

【Objective】 To compare the efficacy of radiofrequency thermocoagulation and pulsed radiofrequency for the ganglion impar in treating primary perineal pain. 【Methods】 We analyzed 79 patients with primary perineal pain who underwent radiofrequency thermocoagulation (group A) and pulsed radiofrequency (group B) in the ganglion impar from January 2020 to March 2022. VAS, excellent and good rates, sleep quality, postoperative medication usage, complications, and recurrence were evaluated before and 24 h, 1 W, 1 M, 3 M and 6 M after operation. The differences between the two groups were compared. 【Results】 The VAS score of group A gradually decreased at each level after operation, and the VAS score of group B gradually increased after 24 hours of operation. The differences between the two groups began to appear 1 week after operation, and the differences further increased with the extension of time (P<0.001). In six months after follow-up, the excellent and good rates of group A (86%) was significantly higher than that of group B (22%). In addition to postoperative perineal skin numbness, group A was superior to group B in improving sleep, postoperative oral medication (pregabalin and opioids), and disease recurrence (P<0.05). 【Conclusion】 Radiofrequency thermocoagulation for the ganglion impar can improve the quality of life by reducing pain, improving the excellent and good rates, improving sleep, and reducing recurrence a medication. The effect is better than that of pulsed radiofrequency.

Routine versus selective use of episiotomy in primigravida: a prospective non-randomized case-control study

Background: Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labour. It is an inflicted second-degree perineal tear. Objective of this study was to determine the possible benefits and risks of the use of selective episiotomy versus routine episiotomy during delivery in primigravida.Methods: This is a prospective non-randomized case-control study designed to analyze and compare the maternal outcomes following routine versus selective use of episiotomy in primigravida. In control group, 122 patients were recruited and mediolateral episiotomy was given in all patients; while in study group, 61 patients were recruited, in whom episiotomy was given selectively.Results: In study group 61 patients were recruited, out of which episiotomy can be avoided in 23 (37.7%) of cases. There was no 3rd or 4th degree perineal tear found in any group. Perineal pain score on 3rd day postpartum was less in study group, as compared to control group on bed rest, sitting, walking and defecation.Conclusions: Selective use of episiotomy can improve maternal outcome by reducing perineal lacerations and those having intact perineum can have the best outcome when episiotomy is given selectively.

An evaluation of abnormal puerperium

Background: Puerperium is strictly defined as the period of confinement during and just after birth. It is the period following childbirth during which body tissues specially the genital organ reverts back approximately to the pre-pregnant state both anatomically and physiologically. At some stages some of these well-orchestrated changes can go away resulting in complications which can endanger life.Methods: Retrospective c study was conducted in Department of Obstetrics and Gynecology of M.G.M. Medical College and M. Y. Hospitals, Indore. The cases were selected randomly from the patient who were admitted in M.Y. Hospital who had either a vaginal or caesarean delivery (both in our institution as well as outside institution) during the study period, irrespective of age, parity and registration status. Data was recorded in predesigned coded case report forms and statistical analysis was performed.Results: Authors found that puerperal pyrexia was the most common complication, accounting for 38.96% of total cases. The second most common complication was perineal pain affecting 28.15% of cases. The other complication was wound gaping/discharge (11.71%), mastitis and breast abscess (6.81%), secondary postpartum hemorrhage (5.33%), episiotomy gaping and infection (4%), perineal hematoma (0.59%), wound dehiscence (0.3%) and other rare causes accounted for 4.15% of the complication.Conclusions: Puerperal period is as important as antenatal period. Anaemia, suboptimal personal hygiene as well as improper sterilization can resulted in severe health hazards such as septicemia, disseminated intravascular coagulation as well as death. So, risk factor should be treated vigorously.

Characterization of pain resulting from perineal trauma in women with vaginal delivery / Caracterização da dor decorrente de traumas perineais em mulheres com parto vaginal

ABSTRACT BACKGROUND AND OBJECTIVES: Perineal pain in the puerperium of women with perineal traumas can affect the quality of life and interfere with normal activities and physiological needs. In addition, many obstetric practitioners neglect this symptom and an incipient scientific production about the characterization of this pain is observed. Therefore, this study aimed to compare the characteristics of perineal pain in women with perineal traumas due to episiotomy and laceration, according to the Brazilian Version of the McGill Pain Questionnaire, in a public maternity hospital in the interior of Bahia. METHODS: A cross-sectional study was carried out with 499 postpartum women who had a vaginal delivery and who presented with perineal pain associated with local traumas. RESULTS: The characterization of perineal pain was the same for both traumas, being described as "that jerk", "boring" and "uncomfortable". CONCLUSION: Perineal pain has considerable intensity and causes discomfort in women. Therefore, it is important that the episiotomy is performed in a restricted way and that the professionals seek to use techniques of perineal protection, as this will reduce the frequency of perineal pain and provide greater comfort to the woman in the immediate puerperium.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor perineal no puerpério de mulheres com traumas perineais pode afetar a qualidade de vida e interferir nas atividades habituais e necessidades fisiológicas. Além disso, muitos profissionais da prática obstétrica negligenciam esse sintoma e observa-se uma incipiente produção científica acerca da caracterização dessa dor. Sendo assim, este estudo teve o objetivo de comparar as características da dor perineal em mulheres com traumas perineais decorrentes de episiotomia e laceração, conforme dimensões da Versão Brasileira do Questionário de dor de McGill, em uma maternidade pública do interior da Bahia. MÉTODOS: Estudo transversal realizado com 499 puérperas que tiveram parto vaginal e que apresentaram dor perineal associada a traumas locais. RESULTADOS: A caracterização da dor perineal foi igual para ambos os traumas, sendo descrita como "que repuxa", "chata" e "incômoda". CONCLUSÃO: A dor perineal possui intensidade considerável e causa desconforto nas mulheres. Sendo assim, é importante que a episiotomia seja realizada de forma restrita e que os profissionais procurem utilizar técnicas de proteção perineal, pois, dessa forma, reduzirá a frequência de dor perineal e proporcionará maior conforto à mulher no puerpério imediato.

Efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy / 临床麻醉学杂志

Objective To observe the analgesic efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy.Methods After institutional reviewing board approval and patient consent,a total of 145 parturients requesting epidural labor analgesia and under-going episiotomy were randomized into three groups:M1,M2,and C,where in morphine 1 mg dis-solved in saline 10 ml,morphine 2 mg dissolved in saline 10 ml,or sole saline 10 ml was epidurally given immediately after umbilical cord clamp,respectively.Perineal pain at rest and movement within 24 hours after vaginal delivery were evaluated with present pain intensity (PPI).Further,the time in-terval between a moderate or severe PPI and epidural drug treatment were recorded.Besides,epidural morphine related side effects including nausea,vomiting,pruritus,and urinary retention were ob-served as well.Results The proportion of patients with moderate or severe pain at rest was signifi-cantly lower in group M2 (2.1%)compared to group M1 (15.7)and group C (19.1%)(P <0.05). Further,the time interval between a moderate or severe PPI and epidural drug treatment was signifi-cantly longer in group M2 (15.7±1.4 h)compared to group M1 (11.0±0.9 h)and group C (11.0 ±1.0 h)(P <0.05).No significant difference was found between groups M1 and group C with regard to morphine efficacy.However,the accumulated side effects including nausea,vomiting,pruritus, and urinary retention prominently increased in group M2 (102.1%)compared to group M1 (43.1%) and group C (12.8%)(P <0.05).Conclusion Although epidural morphine 2 mg may significantly decrease and postpone the occurrence of moderate or severe postpartum perineal pain,however,it de-serves consideration before clinical use owing to the increased side effects.

Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial

Objective: To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief. Method: A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. Results: In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20). Conclusions: LFT and HFT are an effective resource that may be included in the routine of maternity wards. .

Ultrasound-guided pudendal nerve pulsed radiofrequency in patients with refractory pudendal neuralgia: Three cases report

Pudendal neuralgia is characterized by severe sharp pain along the innervation area of pudendal nerve, which may be worsened when sitting position. Successful pudendal nerve block is crucial to the diagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendal nerve blocks have traditionally been performed, recently ultrasound-guided pudendal nerve blocks were reported. For the long term effect of nerve block, pulsed radiofrequency was performed under fluoroscopic guidance in some reports. We report our successful experiences of three cases using ultrasound-guided pulsed radiofrequency.

Neuropatía del nervio pudendo post parto vaginal / Pudend Nerv neuropaty postparto vaginal

Se presenta un caso de neuropatía del nervio pudendo, pos parto vaginal en una paciente segundigesta de 30 años, por­tadora de un síndrome muy raro (NPV). La sintomatología mas importante es el dolor perineal que puede asociarse a disfuncion urinaria, anal e incluso sexual; para el diagnostico es importante utilizar dos criteros mayores, o un criterio mayor y dos criterios menores y el tratamiento debe ser siempre secuencial e incluir tres etapas.

We present a pudend nerve neuropathy, pos parto vaginal case in a 30 year old secondgest, carried of a very strange sindrome (NPV). The most important synthomwas perineal pain which can be asociated qith urinary disfunction or even sexual diosfunction; for the diagnosis is important to use two major criterias or una major criteria and two lesser criterias, and the tratment must always be secuencial and must include three stages.