Comparison of Ultrasound-Guided Transgluteal and Finger-Guided Transvaginal Pudendal Nerve Block Techniques: Which One is More Effective?

Kale, Ahmet; Usta, Taner; Başol, Gülfem; Çam, İsa; Yavuz, Melike Yüksel; Gürbüz, Hande

doi:10.5213/inj.1938112.056

Cited by 20 publications

(17 citation statements)

References 36 publications

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“…However, in traditional obstetric PDB placed by midwives and obstetricians, using the finger to identify the pelvic landmarks is a time-tested and feasible way of ensuring optimal placement of the local anesthetic around the pudendal nerve. Also, a recent study comparing digitally guided transvaginal PDB with ultrasound guided trans-gluteal PDP for pudendal neuralgia showed these methods to be equally as effective [14]. Our digitally guided trans-gluteal technique was effective for pain relief in the two women needing rescue PDB.…”

Section: Discussionmentioning

confidence: 61%

Pre-emptive digitally guided pudendal block after posterior vaginal repair

Uustal

2020

Int Urogynecol J

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Introduction and hypothesis The aim of this study was to establish if digitally guided pre-emptive pudendal block (PDB) reduces postoperative pain and facilitates recovery after posterior vaginal repair under local anesthesia and sedation. Methods We carried out a prospective, randomized, double-blind trial in an outpatient surgery facility. Forty-one women between 18 and 70 years of age, scheduled for primary posterior vaginal reconstructive outpatient surgery, completed the study. The surgery was performed using sedation and local anesthesia with bupivacaine/adrenaline. At the end of surgery, 20 ml of either ropivacaine 7.5 mg/ml or sodium chloride (placebo) was administered as a digitally guided PDB. The primary aim was to establish if PDB with ropivacaine compared with placebo reduced the maximal pain as reported by visual analog scale (VAS) during the first 24 h after surgery. Secondary aims were to compare the duration and experience of the hospital stay, nausea, need for additional opioids, and adverse events. Results PDB with ropivacaine after local infiltration with bupivacaine/adrenaline after outpatient posterior repair did not significantly reduce maximal postoperative pain, need for hospital admittance, nausea, or opioid use. Mild transient sensory loss occurred after ropivacaine in two women. Two women the placebo group were unable to void owing to severe postoperative pain, which was resolved by a rescue PDB. Conclusions When bupivacaine/adrenaline is used for anesthesia in posterior vaginal repair, PDB with ropivacaine gives no benefit regarding postoperative pain, recovery or length of hospital stay. Rescue PDB can be useful for postoperative pain relief.

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Section: Discussionmentioning

confidence: 61%

Pre-emptive digitally guided pudendal block after posterior vaginal repair

Uustal

2020

Int Urogynecol J

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“…When the entire pelvic floor is involved, administering a pudendal nerve block can provide similar relief while minimizing the number of injections required. This can be done in the office setting, using exactly the same procedure as one would use for women in labor 48,49 . There is no research exploring the use of pudendal blocks in MPPS, although its use in treating pudendal neuralgia is documented 48 .…”

Section: Treatment For Myofascial Painmentioning

confidence: 99%

“…This can be done in the office setting, using exactly the same procedure as one would use for women in labor 48,49 . There is no research exploring the use of pudendal blocks in MPPS, although its use in treating pudendal neuralgia is documented 48 . Contraindications to anesthetic injections include anticoagulation or bleeding disorders, local infection, suspected abdominal hernia, and allergy to anesthetic.…”

Section: Treatment For Myofascial Painmentioning

confidence: 99%

Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain

Ross

Detterman

Hallisey

2021

J Midwife Womens Health

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Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.

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“…A randomized controlled trial by Bellingham et al showed that injections with a mixture of a long-acting local anesthetic and corticosteroids performed either by fluoroscopic or US guidance are equally effective (78) . Due to the vicinity of the sciatic nerve, a temporary adverse effect of numbness or foot drop may develop following the injection (73) .…”

Section: Pudendal Neuralgiamentioning

confidence: 99%

“…According to the Nantes criteria published by Labat et al ., at least five clinical presentations must be present in order to diagnose pudendal neuralgia: (1) pain in the pudendal nerve innervation area, (2) predominantly while sitting, (3) not present during the night, (4) without any objective sensory impairment, and (5) relieved after the pudendal nerve block ( 72 ) . US-guided injections represent the best diagnostic and treatment options ( 5 , 73 ) . MRI is considered in diagnostic dilemmas in order to exclude structural abnormalities in the course of the pudendal nerve ( 68 , 74 ) .…”

Section: Pudendal Neuralgiamentioning

confidence: 99%

Ultrasound-guided injections in pelvic entrapment neuropathies

et al. 2021

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Pelvic entrapment neuropathies represent a group of chronic pain syndromes that significantly impede the quality of life. Peripheral nerve entrapment occurs at specific anatomic locations. There are several causes of pelvic entrapment neuropathies, such as intrinsic nerve abnormality or inflammation with scarring of surrounding tissues, and surgical interventions in the abdomen, pelvis and the lower limbs. Entrapment neuropathies in the pelvic region are not widely recognized, and still tend to be underdiagnosed due to numerous differential diagnoses with overlapping symptoms. However, it is important that entrapment neuropathies are correctly diagnosed, as they can be successfully treated. The lateral femoral cutaneous nerve, ischiadic nerve, genitofemoral nerve, pudendal nerve, ilioinguinal nerve and obturator nerve are the nerves most frequently causing entrapment neuropathies in the pelvic region. Understanding the anatomy as well as nerve motor and sensory functions is essential in recognizing and locating nerve entrapment. The cornerstone of the diagnostic work-up is careful physical examination. Different imaging modalities play an important role in the diagnostic process. Ultrasound is a key modality in the diagnostic work-up of pelvic entraptment neuropathies, and its use has become increasingly widespread in therapeutic procedures. In the article, the authors describe the background of pelvic entrapment neuropathies with special focus on ultrasound-guided injections.

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Comparison of Ultrasound-Guided Transgluteal and Finger-Guided Transvaginal Pudendal Nerve Block Techniques: Which One is More Effective?

Cited by 20 publications

References 36 publications

Pre-emptive digitally guided pudendal block after posterior vaginal repair

Pre-emptive digitally guided pudendal block after posterior vaginal repair

Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain

Ultrasound-guided injections in pelvic entrapment neuropathies

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