Pudendal nerve block: a safe, simple and effective approach in surgical proctological patients.

BACKGROUND: Pudendal nerve block (PNB) is commonly used in pudendal neuralgia (PN) and, as anesthesiological technique, in obstetrical and urological procedures. The purpose of this retrospective study was to compare the efficacy of PNB with other anesthesiolocal techniques in proctological surgery. METHODS: A total of 362 patients were seen from a 22-month-time interval. Surgical indication was placed after a conservative therapy. Seventy-eight patients underwent surgery: 42 with spinal anesthesia with PNB and 36 with PNB alone according to their anatomical characteristics. All the patients underwent PNB in lithotomy position and with a perirectal approach. The success rate of PNB was evaluated in postoperative pain control with the VAS score, after the first and the second evacuation. The follow-up also included a third check on the seventh day after surgery. RESULTS: In postoperative period, the mean VAS score found after the first evacuation in patients undergoing PNB was 2.66, after the second evacuation was 1.55, while the VAS score on the seventh day was 0.38. The mean VAS score in the group who underwent spinal anesthesia and PNB were respectively 3.71 and 1.80 after the first and second evacuation. The VAS score calculated on the seventh day was 0.50. There were no statistically significant differences in the VAS score between the 2 groups (P>0.05). CONCLUSIONS: PNB may be a valid alternative to spinal anesthesia in proctological patients. PNB has proven to be both safe and effective technique.

Treatment of Acute Necrotising Pancreatitis and Its Complications: The Surgeon's Perspective.

Acute necrotising pancreatitis (ANP) is associated with high complication and mortality rates. It is still difficult for the surgeon to choose and schedule the most appropriate treatment. Compared to the past, the current minimally invasive "step-up" approach enables better outcomes in terms of morbidity/mortality, notwithstanding long periods of hospitalisation, and above all ensures better levels of residual pancreatic function. We hereby report the case of a patient hospitalised in our division for approximately 4 months with a diagnosis of ANP complicated by infection and late bleeding, handled with a sequential approach.