The Effect of Preemptive Pudendal Nerve Blockade on Pain After Transvaginal Pelvic Reconstructive Surgery (original) (raw)
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Pelvic Pain of Pudendal Nerve Origin: Surgical Outcomes and Learning Curve Lessons
Journal of Reconstructive Microsurgery, 2015
Reconstructive microsurgery may directly involve the pudendal nerve during vaginal reconstruction, 1-4 groin hydradenitis suppurativa reconstruction, 5,6 rectal reconstruction, 7-9 transgender reconstruction, 10-12 inferior gluteal artery perforator flaps for breast reconstruction, 13-16 labial reconstruction, 17-19 salvage procedures after gynecologic mesh interventions for urinary incontinence, 20-22 and following urologic procedures such as prostatectomy. Injury to the branches of the pudendal nerve results in pain syndromes that have proven difficult to treat, with success rates for the most commonly done surgical approach having an expectation that 70% of patients will improve by > 2 on a 10-point Likert scale, and just 20% achieving an excellent result (►Table 1). Recognizing that peripheral nerve surgery is the basis for treatment of refractory pelvic pain related to the pudendal nerve, it is incumbent for the reconstructive microsurgeon to approach the problem from the standpoint of (1) determining that the pudendal nerve is the nerve primarily transmitting Keywords ► pudendal nerve ► neurolysis ► neuroma
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.
Journal of reconstructive microsurgery, 2017
Background This study describes outcomes from a new surgical approach to treat "anterior" pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients...