Response to Pudendal Nerve Block in Women with Pudendal Neuralgia

Vancaillie, Thierry G.; Eggermont, Julie; Armstrong, G; Jarvis, Sherin K.; Liu, Jinzhu; Beg, Natasha

doi:10.1111/j.1526-4637.2012.01343.x

Cited by 61 publications

(36 citation statements)

References 33 publications

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“…Anaesthetic blocks were considered to be positive in 82% of cases (greater than 50% reduction in pain postinfiltration), similar to the results reported by Vancaillie:19 87% of blocks conducted in 66 female patients with PN were positive. In the present study, the absence of any difference in efficacy according to whether the anaesthetic block was positive suggests a placebo effect.…”

Section: Discussionsupporting

confidence: 74%

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

Riant

Lassaux

et al. 2016

BJOG

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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.

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Section: Discussionsupporting

confidence: 74%

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

Riant

Lassaux

et al. 2016

BJOG

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“…Various approaches have been described for pudendal nerve blockade (S2-S4 blockade, transgluteal approach, transvaginal approach). [35][36][37] It is possible to visualize pudendal nerve with US in extrapelvic localization. In patients undergoing TUR-P, it was reported that postoperative analgesia was better in US guided pudendal nerve blockade performed with transperineal approach.…”

Section: Pudendal Nerve Blockadementioning

confidence: 99%

Ultrasound guided chronic pain interventions (Part I)

Akkaya

Alptekin

Özkan

2015

Agri

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SummaryRecently, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy or computed tomography. Latest publications in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expand its applications in algology practice. This review highlights different applications of US in chronic pain conditions. Keywords: Chronic pain; nerve blocks; ultrasound. ÖzetSon zamanlarda rejyonal anestezi pratiğinde ultrasonografi (US) vazgeçilmez görüntüleme tekniği olarak yerini almıştır. Ultrasonografi ile kas/iskelet, periferik ve nöraksial bölgelerin kronik ağrılı patolojilerde çeşitli invaziv girişimler yapmak olasıdır. Bu girişimler diagnostik bloklar, radyofrekans uygulamaları ve nörolitik ajanların uygulamaları olarak özetlenebilirler. Algolojik girişimler esnasında US; hedef dokuların görüntülenmesinde, uygulanan ilacın yayılımında, çevredeki vasküler yapıların görün-tülenmesinde büyük kolaylıklar sağlar. Ayrıca US ile floroskopi veya bilgisayarlı tomografi uygulamaları esnasındaki radyasyon yayılımı söz konusu değildir. Kronik ağrı girişimlerinde US ile yayınlanan klinik çalışmalar umut vericidir. Ayrıca son yıllarda bu alandaki gelişmeler (ekojen iğneler, üç boyutlu US cihazları vd.) US'nin algoloji pratiğindeki kullanımının daha da yaygınlaşaca-ğını düşündürmektedir. Bu derlemenin amacı, US eşliğinde yapılan çeşitli kronik ağrı girişimlerini gözden geçirmektir.

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“…9 Treatments vary from prescription of anti-inflammatory medication to surgical decompression via fasciotomy. 5,8 Typically, the pudendal nerve is thought to comprise nerve roots S2ÀS4 (Figure 1). Although some variations exist, most of the innervation (85%) is from the S2 level.…”

mentioning

confidence: 99%

“…Both males and females can be diagnosed with pudendal neuralgia; however, rates are often higher in females due to a combination of altered structure and stability during and after pregnancy. 5,8 Correct diagnosis commonly takes several years (average ¼ 5.52 years). 8 Pudendal nerve injury often occurs from compression of the nerve in the Alcock canal, a small opening between the obturator fascia and the obturator internus muscle that houses the pudendal vein, artery, and nerve.…”

mentioning

confidence: 99%

“…5,8 Correct diagnosis commonly takes several years (average ¼ 5.52 years). 8 Pudendal nerve injury often occurs from compression of the nerve in the Alcock canal, a small opening between the obturator fascia and the obturator internus muscle that houses the pudendal vein, artery, and nerve. 9 Treatments vary from prescription of anti-inflammatory medication to surgical decompression via fasciotomy.…”

mentioning

confidence: 99%

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Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report

Leone

Middleton

2016

Journal of Athletic Training

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Objective: To discuss the case of a 49-year-old man who presented to the sports medicine staff with pelvic pain of 10 years' duration consistent with pudendal neuralgia.Background: Testicular pain in men is often provoked by direct trauma or may indicate an oncologic process.Differential Diagnosis: Epididymitis, athletic pubalgia, testicular tumor, sacroiliac joint dysfunction, lumbar radiculopathy.Treatment: The patient responded positively to treatment and rehabilitation to restore normal mechanics to the lumbopelvic-hip complex. Several flare-ups since the initial treatment have been of short duration (,2 days) and less intense.Uniqueness: Pudendal neuralgia tends to affect females more than males due to changes in the alignment and stability of the pelvis from a combination of a shorter, wider pelvis and muscle imbalances associated with childbirth. Typically, males with testicular pain suffer from epididymitis or some type of testicular torsion, which was not the situation in this case. Compression is also a common cause of pudendal neuralgia, although it was not responsible for this patient's pain, making diagnosis and treatment complex.Conclusions: Many pain syndromes can be treated with removal of the original stimulus. However, recognizing the factors contributing to pelvic pain and dysfunction in males can be a challenge for the sports medicine professional. A vigilant and unassuming approach to male pelvic pain is warranted, particularly by health care providers in diverse practice settings.

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Response to Pudendal Nerve Block in Women with Pudendal Neuralgia

Abstract: In patients with pudendal neuralgia, the pudendal nerve block has a variable response, but may have a beneficial effect in a subset of women. Surgical and obstetrical trauma are common historical antecedents.

Cited by 61 publications

References 33 publications

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

Ultrasound guided chronic pain interventions (Part I)

Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report

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