Computed Tomography-Guided Pudendal Nerve Block. A New Diagnostic Approach to Long-Term Anoperineal Pain: A Report of Two Cases (original) (raw)
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A Novel Technique for Pudendal Nerve Block
July 2004, 2004
Pudendal nerve block is performed to confirm the diagnosis of pudendal neuralgia. Many physicians and patients are hesitant to pursue diagnostic nerve blocks to confirm the diagnosis of pudendal neuralgia secondary to significant patient discomfort, the need for special equipment, and the risk in the traditionally described approach. Objective: To describe a novel technique for pudendal nerve block with minimal risk and decreased patient discomfort. Description of the Technique: With the patient in the prone position, the C-arm is projected in the anteroposterior position until the pelvic inlet is visualized. Subsequently, the ischial spine is highlighted by 5 to 15 degree ipsilateral oblique angulation of the fluoroscope. A 25-gauge 3.5 cm needle is advanced to the tip of the ischial spine where the pudendal nerve transiently leaves the pelvis. The pudendal nerve block is performed at this level. Conclusion: We described a new and novel technique to block pudendal nerve under fluoroscopic visualization safely with increased patient comfort.
La Radiologia medica, 2009
The authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature. Twenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock's) canal. One patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a>or=20% improvement in the Quality of Life (QOL) i...
Response to Pudendal Nerve Block in Women with Pudendal Neuralgia
Pain Medicine, 2012
Objective. To examine the evolution of pain and the duration of numbness after neural blockade of the pudendal nerve in women with pudendal neuralgia and correlate with clinical and historical data. Design. Prospective, single arm, open label study. Setting. University hospital and outpatient clinic. Subjects. Eighty-two adult female patients were recruited from November 8, 2008 to February 14, 2010. Patients were selected based on the presence of spontaneous or provoked pain in the distribution of the pudendal nerve. Interventions. Subjects underwent a standardized pudendal nerve block. Outcome Measures. Visual analog pain scores and the presence of numbness were recorded before and for 64 hours after the pudendal nerve block. A complete clinical history and examination were documented.
Anatomical basis of transgluteal pudendal nerve block
Surgical and Radiologic Anatomy, 2009
Background The pudendal nerve may become entrapped either within the pudendal canal or near the sacrotuberous ligament resulting in a partial conduction block. The goal of the present anatomical study was to assess a new transgluteal injection technique in terms of the precise injection site and the resulting distribution of the injected agent. Materials and methods This study was carried out using eight fresh human cadavers. An epidural needle with a removable wing was inserted and the catheter position visualized using MRI. Through the catheter 10 ml of gadolinium contrast medium was injected into three of the cadavers. A further four cadavers were injected with latex and blue pigment and the pelvi-perineal area of each then separated from the trunk for freezing before being cut into 4-8 mm thick sections with an electric bandsaw. One Wnal cadaver was injected with a mix of gadolinium (5 ml) and latex (5 ml) and both the MRI and anatomical procedures outlined above were performed.
Regional anesthesia and pain medicine, 2016
Ultrasound-guided techniques for pudendal nerve block have been described at the level of the ischial spine and transperineally. Theoretically, however, blockade of the pudendal nerve inside Alcock canal with a small local anesthetic volume would minimize the risk of sacral plexus blockade and would anesthetize all 3 branches of the pudendal nerve before they ramify in the ischioanal fossa. This technical report describes a new ultrasound-guided technique to block the pudendal nerve. The technique indicates an easy and effective roadmap to target the pudendal nerve inside the Alcock canal by following the margin of the hip bone sonographically along the greater sciatic notch, the ischial spine, and the lesser sciatic notch. The technique was applied bilaterally in 3 patients with chronic perineal pain. The technique described was also used to locate the pudendal nerve within Alcock canal and inject dye bilaterally in 2 cadavers. Complete pinprick anesthesia was obtained in the puden...
Regional anesthesia guided by ultrasound in the pudendal nerve territory
Colombian Journal of Anesthesiology
Introduction: Pudendal nerve blocks have a wide range of clinical applications for the management of acute post-operative pain in urologic, gynecological surgery, in coloproctology, as well as in pain medicine for differential diagnosis, and for the management of pudendal neuropathies. However, despite its benefits it is infrequently used. Objective: To perform a detailed description of the most recent ultrasound-guided techniques with the aim of encouraging safe and reproducible learning. Materials and methods: We have performed a broad, non-systematic review of the literature through Medline, Embase and Science Direct between 1985 and 2016, to evaluate the most relevant articles, using the following key words: pudendal nerve anatomy, pudendal nerve, pudendal nerve blocks, pudendal nerve ultrasound, pudendal neuralgia, nerve entrapment, chronic pain, Alcock canal, and pelvic pain. The search was limited to articles published in Spanish, English and French. Results: Recent descriptions were found of a large number of anatomic variants, which are described in detail and shown in graphic documents in order to facilitate the sonoanatomic correlation of nerve location as a guide for the performance of the pudendal nerve block through the different approaches.
Magnetic resonance imaging of pudendal nerve: technique and results
Pelviperineology, 2021
INTRODUCTION Since its first description in 1992 and subsequent years, magnetic resonance imaging (MRI) of pudendal nerve has rapidly gained wide acceptance by the medical community as a valuable tool for decision-making and therapy planning in patients with chronic pelvic pain syndromes. The term “MRneurography” has come into practical use to describe the direct depiction of nerves in the body using special modifications of the standard MR imaging technique which allow detection of the signal arising from inside the nerve itself rather than from the surrounding tissues. More specifically, given the intraneural source of the signal, the images obtained during the examination were thought to provide important information about the internal state of the nerve such as the presence of irritation, nerve swelling, compression, pinch or injury. From the technical point of view, the basic principle for a successful examination includes suppression of the signal coming from the bright fat, s...