超声引导下PNB联合PCIA在盆底手术术后镇痛中的应用价值OA

Objective:To explore the application value of ultrasound-guided pudendal nerve block(PNB)combined with patient-controlled intravenous analgesia(PCIA)in the post-operative period of pelvic floor surgery.Methods:A total of 120 female patients who underwent transvaginal or abdominal reconstructive surgery for pelvic organ prolapse under general anes-thesia in the Department of Gynecology,Zhengzhou Central Hospital from May 2024 to April 2025 were enrolled.The patients were divided into a transvaginal surgery subgroup and anab-dominal surgery subgroup according to surgical approach,and were randomly assigned to three groups using a random number table:Group A(n=40)received patient-controlled intravenous analgesia(PCIA);Group B(n=40)underwent ultrasound-guided pudendal nerve block(PNB);Group C(n=40)received PNB combined with PCIA.Painscores at different time points after surgery were recorded using the visual analogue scale(VAS).The time to first am-bulation and the time to first successful removal of the urinary catheter were documented.In ad-dition,analgesia satisfaction within 48 hours,cumulative consumption of PCIA drugs,incidence rates of adverse reactions such as nausea,vomiting and bradycardia,as well as the incidence of complications related to pudendal nerve block were recorded.Results:Analgesic effect:in both subgroups,Group C showed superior analgesic effect throughout the observation period.There was no significant difference between Group A and Group B at the early postoperative time points(2h,6h,and 12h after surgery).At the late postoperative time points(24h and 48h after surgery),the analgesic effect of Group A was better than that of Group B(after Bonferroni cor-rection,the significance level was set at P<0.0167).Postoperative recovery:the time to first ambulation and the time to first successful removal of the urinary catheter in Group C were sig-nificantly earlier than those in Group A and Group B(P<0.0167),with no significant differ-ence between Group A and Group B(P>0.0167).Drug consumption:in both subgroups,the cumulative consumption of PCIA drugs within 48h in Group C was significantly lower than that in Group A(P<0.05).Analgesia satisfaction:patient satisfaction with analgesia in Group C was significantly better than that in Group A and Group B in both subgroups(P<0.0167),with no significant difference between Group A and Group B(P>0.0167).Safety:the overall inci-dence of adverse reactions was low in all three groups.The incidence of nausea and vomiting in Group A was significantly higher than that in Group B and Group C in both subgroups(P<0.0167),with no significant difference between Group B and Group C(P>0.0167).There were no significant differences among the three groups in the incidence of dizziness,bradycardi-a,or severe complications(respiratory depression,nerve block-related complications)(P>0.05).Conclusion:Ultrasound-guided PNB combined with PCIA can significantly relieve post-operative pain in patients undergoing transvaginal and transabdominal pelvic floor reconstruc-tion,shorten the time to first ambulation and catheter removal,effectively reduce opioid con-sumption and the risk of adverse reactions such as nausea and vomiting,and improve patient comfort and subjective analgesic experience,showing a promising clinical application prospect.