New, simple, ultrasound-guided infiltration of the pudendal nerve (original) (raw)
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High‐Resolution ultrasound of the pudendal nerve: Normal anatomy
2012
Introduction: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures. Methods: Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MHZ) and high-frequency (12-7-MHZ and 17-5-MHZ) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility. Results: Visualization of the pudendal nerve at the ischial spine was best when using a medial approach (P < 0.004); the terminal branches were seen best with the anterior approach (P < 0.002). Conclusion: High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches.
New, simple approach for maximal pudendal nerve exposure
Diseases of the Colon & Rectum, 2000
PURPOSE: Functional neosphincters after pudendal nerve anastomosis proved possible in animal models and may be applicable in humans, but access is a recognized problem. We report the occurrence of pudendal nerve anomalies, its implications for reconstruction, and describe a new approach for maximal exposure. METHODS: Adult human cadavers were positioned prone and dissected via a gluteal approach. Pudendal nerve variations and physical measurements were analyzed statistically. RESULTS: A new, simple, four-step approach (surface landmarks and exposure of gluteus ma_ximus muscle, sacrotuberous ligament, and pudendal neurovascular bundle) permitted optimal pudendal nerve exposure in all 14 human cadavers (28 limbs). Six were males and had a mean age of 82 (range, 58-102) years. Two anomalies, Type 1 (2-tnmked) and Type 2 (3-mmked), of the pudendal nerve were recogl~zed in 30 percent of cadavers, with a left-to-right ratio of 2.5:1. Mean pudendal nerve length over the ischial spine was 23.9 (range, 19-28) mm right, 24.2 (range, 19-28) mm left (P = 0.54), but its diameter measured 5.2 mm (right) and 4.9 nm~ (left; P = 0.04). Mean length of pudendal nerve trunk exposed after reflection of the sacrotuberous ligament was 55 (range, 44-75) mm on either side before division into terminal branches. The number and percent frequency of inferior rectal nerve on both sides were 1 (13 percent), 2 (76 percent), and 3 (11 percent), respectively, with a mean length of 27.1 (range, 21-34) mm right and 27.9 (range, 20-33) mm left (P = 0.31). CONCLUSION: A simple fourstep approach to the pudendal nerve contributes to improved access in all cases. It facilitates reconstruction because it allows accurate nerve selection and recognition of potential anomalies that might influence functional outcome.
Pudendal Nerve 3-Dimensional Illustration Gives Insight Into Surgical Approaches
Annals of Plastic Surgery, 2014
The pudendal nerve is located topographically in areas in which plastic surgeon reconstruct the penis, the vagina, the perineum, and the rectum. This nerve is at risk for either compression or direct injury with neuroma formation from obstetrical, urogynecologic, and rectal surgery as well as pelvic fracture and blunt trauma. The purpose of this study was to create a 3dimensional representation based on magnetic resonance imaging of the pelvis supplemented with new anatomic dissections in men and women to delineate the location of the pudendal nerve and its branches, providing educational information both for surgical intervention and patient education. The results of this study demonstrated that most often there are at least 2, not 1, ''pudendal nerves trunks'' as they leave the pelvis to transverse the sacrotuberous ligament, and that there are most often 2, not 1, exit(s) from Alcock canal, one for the dorsal branch and one for the perineal branch of the pudendal nerve.
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...
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...