Dual Site Pudendal Nerve Infiltration: More than Just a Diagnostic Test?

Abstract

Background: Pudendal neuralgia (PN) is a very painful and often disabling condition in which pudendal nerve blocks play an important role in both the diagnosis and management of PN. Some previous reports have advocated the use of pudendal nerve infiltration (PNI) as a diagnostic test only. Objective: We aim to assess the outcomes of patients with typical refractory PN who underwent dual site computed tomography (CT)-guided pudendal nerve infiltration. Study Design: A bicentric, retrospective cohort analysis. Setting: An academic practice. Methods: Between 2002 and 2016, 385 PNIs were performed in 195 patients in the 2 units. Only patients suffering from typical clinical PN were included, and only the first infiltration in each patient was considered for analysis. Therefore, 95 patients who underwent 155 procedures were assessed. Pain was assessed using a visual analog scale (0–10) and self-reported estimated improvement (SRI), expressed as a percentage. Efficacy of the procedure was assessed at 1, 3, and 6 months after procedure follow-up, and clinical success was defined as a 50% decrease of the VAS score. All procedures were performed under CT guidance and on an outpatient basis. Dual site infiltration was performed in each case at both the ischial spine and intra-Alcock’s canal sites using a mixture of fast- and slow-acting anesthetic (1 mL lidocaine hydrochloride 1% and 2 mL ropivacaine chlorhydrate) along with a half dose of 1.5 mL of cortivazol (3.75 mg). Results: Clinical success at one month post-procedure was present in 63.2% of patients (60/95) with a mean VAS score of 2.07 (P < 0.05) and a mean SRI of 71%. At 3 months follow-up, clinical success was still present in 50.5% of patients (48/95) with a mean VAS score of 2.90/10 (P < 0.05) and a mean SRI of 62.3%. At 6 months follow-up, the efficacy rate decreased to 25.2% with a mean VAS score of 3.2/10 and SRI of 60%. Limitations: The retrospective aspect of the study is a limitation, as well as the lack of a control group. Conclusion: Dual site PNI under CT guidance may offer significant mid-term pain relief to a majority of patients suffering from typical refractory PN. Key words: Pudendal nerve, neuralgia, block, Alcock, CT, guidance

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

“…Although, PNI is commonly used for diagnostic purposes [11,35], it may also be performed as a therapeutic procedure in patients with refractory PN [6]. According to our study, it was observed that patients who underwent pudendal nerve block had significant pain relief for a long period in both groups.…”

“…Similar to our results, Fanucci et al [9] showed an improvement in pain intensity in 92.6% of patients using CT-guided PNI at the 6-month follow-up. Another previous study reported the efficacy of the CT-guided technique with a mean VAS score of 3.2 at the 6-month follow-up [6]. However, the CT-guided technique requires a radiologic facility and an experienced radiologist, and it exposes the patient to radiation.…”

“…Pudendal nerve infiltration (PNI), which was defined as an essential step, is performed for diagnostic purposes and as an important treatment modality in patients with PN [6][7][8][9][10][11]. This approach aims for long-term relief of pain, as in all forms of nerve entrapment syndromes, by treating a possible inflammatory component, it also provides neuroprotection to the central nervous system and reduces spontaneous ectopic activity of the affected nerve [12,13].…”

A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review

“…Furthermore, pain evaluation was made using simple scoring methods (VAS and SRI scores) which are subjective. 59 …”

Functional Disorders After Colorectal Surgery/IBS

“…However, we prefer CT-guided pudendal nerve blocks with injection into the sacrospinous ligament and Alcock's canal. A retrospective review of 95 patients who underwent CT-guided injection of both locations using a combination of lidocaine hydrochloride, ropivacaine chlorhydrate, and cortivazol demonstrated clinical success as defined by at least a 50% reduction in baseline pain scores in 63% of patients at 1-month postprocedure, 50% of patients at 3 months, and 25% of patients at 6 months with no major complications [87]. The efficacy of using steroids in nerve injection was investigated in a randomized, double-blind, controlled study comparing CT-guided pudendal nerve blocks with a local anesthetic versus local anesthetic and corticosteroid.…”