不同阻滞方法治疗阴部神经痛的疗效与安全性分析

Efficacy and safety of different nerve block methods for the treatment of pudendal neuralgia

目的探讨CT引导下经第三骶后孔置管阴部神经阻滞治疗阴部神经痛(PN)的有效性和安全性。方法回顾性分析2020年1月至2023年4月在清华大学附属北京清华长庚医院疼痛科治疗的222例PN患者,根据患者治疗方法分为两组:经第三骶后孔置管阴部神经阻滞(观察组,n=101)和超声引导下阴部神经阻滞(对照组,n=121)。主要观察指标为术后90 d疼痛缓解率,次要观察指标为治疗后1、7、14、30、90 d疼痛视觉模拟评分(VAS)、术后曲马多使用率、焦虑自评量表(SAS)评分和不良反应的发生率。采用二元logistic回归分析治疗后90 d疼痛缓解影响因素。结果观察组男34例,女67例,年龄(49.8±16.0)岁;对照组男38例,女83例,年龄(43.7±14.0)岁;观察组患者术后90 d疼痛缓解率为38.6%(39/101),高于对照组患者的24.0%(29/121)(P=0.018)。观察组与对照组治疗后VAS评分均呈现时间与组别的交互效应(均P<0.05)。组内比较,两组患者治疗后1、7、14、30、90 d的VAS评分均低于治疗前(均P<0.05);组间比较,观察组患者术后1、7、14、30、90 d的VAS评分与对照组相比差异均无统计学意义(均P>0.05)。观察组患者术后90 d的SAS评分为(51.5±6.2)分,低于对照组的(53.4±5.8)分(P=0.022)。两组患者术后曲马多使用率和不良反应发生率差异均无统计学意义(均P>0.05)。经第三骶后孔置管阴部神经阻滞是PN患者术后90 d疼痛缓解的保护因素(OR=1.92,95%CI:1.05~3.48,P=0.033)。结论经第三骶后孔置管阴部神经阻滞是一种安全、有效的微创治疗方式,具有更高的术后90 d疼痛缓解率,不增加术后补救镇痛药物的使用率和不良反应的发生率。

Objective To identify efficacy and safety of pudendal nerve block in tubing through the third posterior sacral foramen for the treatment of pudendal neuralgia(PN).Methods A retrospective study with 222 PN patients was conducted in the Department of Pain Management of Beijing Tsinghua Changgung Hospital from January 2020 to April 2023.These patients were divided into two groups based on their treatment methods:pudendal nerve block in tubing through the third posterior sacral foramen(observation group,n=101)and ultrasound-guided pudendal nerve block(control group,n=121).Primary outcome measure was the 90-day postoperative pain relief rate.Secondary outcome measures included visual analog scale(VAS)at 1,7,14,30 and 90 d after surgery,the incidence of tramadol uses after surgery,postoperative self-rating anxiety scale(SAS)scores and the incidence of adverse events.Factors that influenced pain relief within 90 days after surgery were analyzed by using binary logistic regression analysis.Results Observation group included 34 males and 67 females,aged(49.8±16.0)years old.Control group included 38 males and 83 females,aged(43.7±14.0)years old.The 90-day postoperative pain relief rate of the observation group patients was 38.6%(39/101),which was higher than the 24.0%(29/121)of the control group patients(P=0.018).Both the observation group and the control group showed an interaction effect of time and group after treatment for VAS scores(both P<0.05).In intra-group comparison,the VAS scores at 1,7,14,30 and 90 d after treatment in both groups were lower than those before treatment(all P<0.05).In inter-group comparison,the differences of the VAS scores were not statistically significant in the observation group compared with those in the control group at 1,7,14,30 and 90 d after surgery(all P>0.05).The SAS score of the observation group at 90 d after surgery was 51.5±6.2,which was lower than the 53.4±5.8 of the control group(P=0.022).There was no statistically significant difference in the incidence of postoperative tramadol uses and adverse events between the two groups(both P>0.05).Pudendal nerve block in tubing through the third posterior sacral foramen was a protective factor for pain postoperative relief in PN patients at 90 d after surgery(OR=1.92,95%CI:1.05-3.48,P=0.033).Conclusion Pudendal nerve block in tubing through the third posterior sacral foramen is a safe and effective minimally invasive treatment.It has a higher postoperative pain relief rate within 90 d after surgery,without increasing the uses of postoperative rescue analgesics and the incidence of adverse events.