C-arm-guided pudendal nerve block: a new technique

Abstract

Pudendal nerve block (PNB) is an effective diagnostic and/or treatment method for perineal pain. Various approach techniques, such as transperineal, transvaginal, computerised tomography (CT)- or sono-guided approach, have been suggested for this block. However, they have some limitations, such as high cost, difficulty to perform in practice, inaccurate and unreliable results and inconvenience. To overcome these limitations, we first tried C-arm-guided approach for accomplishing PNB in the prone position. Under the optimal ischial spine view of C-arm fluoroscopy, the block needle was placed on the tip of the ischial spine. Then a mixed solution for the block was administered. All of the 25 patients enrolled in this study were blocked successfully using this method. No side-effects or complications were observed in relation to the block. We concluded that the C-arm-guided approach for PNB is an effective alternative to the existing techniques, which can overcome their limitations.

Pudendal nerve blocks in men undergoing urethroplasty: a case series

“…The ischial spine is an important landmark for both nonguided and image-guided PNB. Injecting anesthetic medial to the ischial spine maximizes distance of the needle trajectory from important structures such as nerves and the pudendal artery [10]. Both the ischial spine and the sacrospinous ligament can be visualized easily using ultrasound.…”

Anterior Approach for Ultrasound-guided Pudendal Block

“…Literature provides several techniques to block the pudendal nerve, all of which depend on localizing the anatomic landmarks around the nerve [6][7][8]. The most common approach has been fluoroscopic guidance, where the needle is aimed to be placed as close as possible to the ischial spine.…”

Pudendal Nerve Blockade

“…Additionally, spread can occur along the ipsilateral obturator internus muscle, sacrotuberous ligament, or sacrospinous ligament. Investigators have not described any particular correlation between pattern of spread and success of sensory blockade [ 54 ].…”