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

Jj, Labat; Riant, T.; Lassaux, A.; Rioult, B.; Rabischong, B.; Khalfallah, M.; Volteau, Christelle; Leroi, A.-M.; Ploteau, Stéphane

doi:10.1111/1471-0528.14222

Cited by 65 publications

(54 citation statements)

References 21 publications

(24 reference statements)

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“…Notably, the addition of steroid in our study failed to contribute any relief in 15 (21.7%) of the positive initial injections and two (18.2%) of the positive repeat injections albeit this was not formally assessed. This effect mirrors the results of a recent randomized controlled trial on the addition of corticosteroid to the pudendal nerve block in pudendal neuralgia and strengthens the argument for its omission …”

Section: Discussionsupporting

confidence: 79%

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

Dickson

Higgins

Sehgal

et al. 2019

ANZ Journal of Surgery

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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.

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Section: Discussionsupporting

confidence: 79%

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

Dickson

Higgins

Sehgal

et al. 2019

ANZ Journal of Surgery

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“…Respondents to the treatments could be defined as the one with improvement or disappearance of one or more of the essential signs and symptoms disclosed in the Nantes' criteria. The 2017 randomized trial of Labat et al 36 already follows this experimental design.…”

Section: Discussionmentioning

confidence: 99%

Estimate of the proportion of uncertain diagnoses of pudendal neuralgia in women with chronic pelvic‐perineal pain: A systematic review with a descriptive data synthesis

Indraccolo

Nardulli

Indraccolo

2020

Neurourology and Urodynamics

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Background There is a gap between pudendal neuralgia (PN) due to pudendal entrapment syndrome and PN without pudendal entrapment syndrome. The latter could have atypical symptoms. Aim Defining a rate of atypical PN from a clinical series of female patients with chronic pelvic‐perineal pain. Methods The atypical PN was defined as a pain not meeting clinical criteria for pudendal entrapment syndrome. The effect size was the rate of atypical PN. Such a rate was expected to be found among patients screened for enrollment in clinical series on pudendal neuropathic pain. A systematic search was performed looking for clinical series on PN. Studies must report information on female patients, pelvic‐perineal pain, at least a clinical criterion for diagnosing the pudendal neurogenic origin of pain, the proportion of patients with pain not meeting the clinical criterion/a for diagnosing the pudendal entrapment pain. Results From 2637 references, nine studies were included for qualitative analysis. Three of them were not suitable for data synthesis: one assessed the rate of PN after hip arthroscopy; second enrolled miscellaneous patients, a third investigated patients with gynecological diseases. Six studies involved patients with suspicion of pudendal entrapment symptoms (205 patients observed), allowing data synthesis. One of these series was judged as being of good quality. The overall rate of atypical PN is 0.013 (95% confidence interval, 0.008‐0.021), I2 0%. Further analysis suggests the risk of bias for all studies. Conclusions Atypical PN in females is low when clinical criteria for pudendal entrapment syndrome are applied.

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“…Once suspected, it can be confirmed with electrodiagnostic studies [185]. When conservative treatments [186] fail, surgical decompression should be considered [187] (Figures 14A-E). The results are often poor, at times because patients are diagnosed much too late due to lack of awareness in the medical world.…”

Section: Pudendal Nerve Entrapmentmentioning

confidence: 99%

Peripheral Nerve Entrapment and their Surgical Treatment

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

MaríaOrtiz‐Criado³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Nerves pass from one body area to another through channels made of connective tissue and/or bone. In these narrow passages, they can get trapped due to anatomic abnormalities, ganglion cysts, muscle or connective tissue hypertrophy, tumours, trauma or iatrogenic mishaps. Nearly all nerves can be affected. The clinical presentation is pain, paraesthesia, sensory and motor power loss. The specific clinical features will depend on the affected nerve and on the chronicity, severity, speed and mechanism of compression.Its incidence is higher under some occupations and is some systemic conditions: diabetes mellitus, hypothyroidism, acromegaly, alcoholism, oedema and inflammatory diseases. The diagnosis is suspected with the clinical presentation and provocative clinical test, being confirmed with electrodiagnostic and/or ultrasonographic studies. Magnetic Resonance Studies (MRI) rule out ganglion cysts or tumours. Conservative medical treatment is often sufficient. In refractory ones, surgical decompression should be performed before nerve damage and muscle atrophy are irreversible. The 'double crash' syndrome happens when a peripheral nerve is compressed at more than one point along its trajectory. In cases with marked muscle atrophy, a 'supercharge end-to-side' nerve transfer can be added to the decompression. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied.

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

Cited by 65 publications

References 21 publications

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

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

Estimate of the proportion of uncertain diagnoses of pudendal neuralgia in women with chronic pelvic‐perineal pain: A systematic review with a descriptive data synthesis

Peripheral Nerve Entrapment and their Surgical Treatment

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