Role of nerve block as a diagnostic tool in pudendal nerve entrapment

Abstract

Background: Pudendal nerve entrapment is a disabling condition which is difficult to diagnose and treat. Nantes criteria include the requirement of positive anaesthetic pudendal nerve block that is widely used to allow identification of patients likely to benefit from the definitive but invasive pudendal nerve release. This study aimed to determine if pudendal nerve blockade under general anaesthesia could diagnose and temporarily treat pudendal nerve entrapment in patients suffering from chronic pelvic/perineal pain and/or organ dysfunction. Methods: This retrospective analysis of a prospectively maintained database examined the outcomes of all recipients of diagnostic pudendal nerve block in a quaternary referral centre between 2012 and 2017. Primary outcome was relief of perineal pain (transient or permanent). Secondary outcomes were demographics, referral patterns for definitive procedure and complication rates. Statistical analysis was performed using SPSS v 24. Results: A total of 77 patients were included in the study. Mean age was 57.27 AE 13.55 years. Majority were females (n = 62, 80.5%). Relief of pain was experienced by 47 of 76 (68.1%) patients after initial injection. Complication rate of injection was 3.9% (n = 3) which in all cases was unilateral lower limb paraesthesia. Of the 37 patients (52.9%) referred, 20 underwent surgical decompression with 12 (60%) being successful. Conclusion: Pudendal nerve injection is a safe and simple procedure that can provide accurate diagnosis and transient relief from this chronic and debilitating problem. This technique helps to isolate patients suitable for pudendal nerve decompression which offers high success rates.

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

“…This approach is standard procedure in the diagnosis of the location of neuropathy in other organs. 90 As applied to PGAD/GPD, the panel reached a consensus that the diagnostic use of anesthesia testing is appropriate (expert opinion). If symptoms are clinically significantly reduced ("very much better" or "much better"), the implication is that pathology in the end organ contributes to the PGAD/GPD.…”

Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome

“…En casos de ausencia de respuesta, la descompresión quirúrgica no sería una opción terapéutica y habría que pensar en otras etiologías 5 . La inyección del nervio pudendo es un procedimiento seguro y simple que puede proporcionar un diagnóstico preciso y un alivio transitorio de esta enfermedad crónica y debilitante; además de ayudar a aislar pacientes adecuados para descompresión del nervio pudendo 51 .…”

Algoritmo diagnóstico y terapéutico del síndrome de atrapamiento del nervio pudendo

“…5 Pudendal nerve injection is a safe and simple procedure that can provide accurate diagnosis and transient relief from this chronic and debilitating condition and help to identify patients suitable for pudendal nerve decompression. 51 An increasingly used technique in cases of chronic pelvic pain, especially in cases of pelvic floor spasms, is the injection of botulinum toxin A. There is no consensus on its use, or on the injection site, or on the dose.…”