Optimizing Postoperative Analgesia After Perianal Abscess Surgery Using Ultrasound-Guided Pudendal Nerve Block Combined with Wrist-Ankle Acupuncture: A Randomized Controlled Trial

Cui Zhang,1,2,* Junyi Yang,1,2,* Linhua Feng,1,2 Xizhong Zhao,1,2 Ping Tang1,2 1Department of Anorectal Surgery, Institute of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine, Chengdu, People’s Republic of China; 2Department of Anorectal Surgery, The Sichuan Second Hospital of Traditional Chinese Medicine, Chengdu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cui Zhang, Email [email protected]: To investigate the efficacy and safety of ultrasound-guided pudendal nerve block (PNB) combined with wrist-ankle acupuncture for postoperative pain management following perianal abscess surgery.Methods: This prospective randomized controlled trial enrolled 120 patients undergoing perianal abscess surgery between January 2023 and June 2024. Patients were randomly assigned to three groups (n = 40 per group): a PNB group, a wrist–ankle acupuncture group, and a combined group (PNB plus wrist–ankle acupuncture). Visual analogue scale (VAS) pain scores at multiple postoperative time points, duration of analgesia, rescue analgesia rate, serum inflammatory markers, sleep quality, patient satisfaction, and adverse events were compared among the three groups.Results: VAS scores at 6, 12, 24, 48, and 72 hours postoperatively were significantly lower in the combined group than in the PNB group and the wrist-ankle acupuncture group (all P < 0.01). The duration of analgesia was significantly longer in the combined group (P < 0.001), while the rescue analgesia rate was significantly lower (15.0%, P < 0.05). At 48 and 72 hours postoperatively, serum levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were significantly lower in the combined group than in either single-intervention group (all P < 0.05). In addition, postoperative sleep quality scores and patient satisfaction were significantly improved in the combined group (P < 0.05). No significant differences in the incidence of adverse events were observed among the three groups (P > 0.05).Conclusion: Ultrasound-guided pudendal nerve block combined with wrist-ankle acupuncture provides more sustained and effective postoperative analgesia after perianal abscess surgery, attenuates inflammatory responses, improves sleep quality, and demonstrates a favorable safety profile. This combined approach may represent a promising multimodal analgesic strategy integrating conventional regional anesthesia and complementary therapy.Trial Registration: International Traditional Medicine Clinical Trial Registry (ITMCTR). Registration No. ChiCTR-2500111901.Clinical Trial Number: ChiCTR-2500111901.Keywords: postoperative analgesia, pudendal nerve block, wrist-ankle acupuncture, ultrasound guidance, perianal abscess