ObjectiveTo compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment.DesignRandomised, double‐blind, controlled trial.SettingMulticentre study.Population201 patients were included in the study, with a subgroup of 122 women.Methods CT‐guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A (n = 68) had local anaesthetic alone, those in Arm B (n = 66) had local anaesthetic plus corticosteroid and those in Arm C (n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline.Main outcome measuresThe primary end‐point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30‐point improvement on a 100‐point visual analogue scale of mean maximum pain over a 2‐week period) or nonresponders.ResultsThree months’ postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant (P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C (P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality‐of‐life criteria.ConclusionsCorticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used.Tweetable abstractSteroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.

This 7-year-old boy with Hajdu-Cheney syndrome presented with cervical syringomyelia related to rapidly progressing platybasia. Decompressive craniectomy provided temporary improvement, and his clinical status was eventually stabilized after external immobilization, according to findings at 2.5 years of follow up. In a review of the literature the authors found 57 cases of the syndrome, only three of which were associated with syringomyelia. The youth of the patient, the severe form and rapid course of the disease, and the very specific anatomical conditions related to cranial and facial deformities raised various therapeutic problems.

(Abstracted from BJOG 2016; DOI: 10.1111/1471-0528.14222) Management of pudendal neuralgia (PN) is often not evidence based. The practice of adding corticosteroids to a nerve block in patients with PN is widespread and largely based on a few studies suggesting that corticosteroids may prolong the effect of a local anesthetic.