Laparoscopic Abdominoperineal excision (APE) remains a key surgical option for low rectal cancers and certain anal malignancies where sphincter preservation is not feasible, particularly for tumours involving the anal sphincter complex. Even with advanced sphincter preserving approaches, laparoscopic APE is sometimes indispensable, especially for ensuring adequate oncologic margins. Postoperative pain, especially from the perineal wound, is a common and significant problem after APE. Standard analgesic strategies for APE such as intravenous opioids and epidural analgesia may be only partially effective for perineal pain and are associated with adverse effects like urinary retention, sedation, and delayed bowel function.

In this context, bilateral pudendal nerve block (PNB) has emerged as a valuable adjunct to conventional analgesia, directly targeting the sensory supply of the perineal region. The pudendal nerve arises from sacral roots S2,S3,S4 and innervates most perineal structures. Bilateral pudendal nerve block performed by anatomical landmark, nerve stimulator, or ultrasound guidance, has been shown in systematic reviews and randomized studies to significantly reduce pain intensity and opioid requirements after perineal surgery, including APE.

The use of PNB is associated with high efficacy, relatively favourable safety profile, and low incidence of complications. Incorporating bilateral PNB into multimodal analgesic protocols for laparoscopic APE thus enhances postoperative pain control, promotes earlier mobilization, reduces opioid-related side effects, and improves patient satisfaction and recovery.