New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

Weinschenk, Stefan; Hollmann, Markus W.; Strowitzki, Thomas

doi:10.1007/s00404-015-3812-0

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Image-guided or finger-guided PNIs can be performed according to the experience of the physician, adequate equipment presence, and patient choice. Over the past 20 years, studies have described the PNI techniques [14][15][16][17][18][19][20], but a limited number of studies have compared the efficacy of image-guided PNI techniques [21]. To the best of our knowledge, there are no studies comparing the finger-guided transvaginal PNI (TV-PNI) and ultrasound (US)-guided transgluteal PNI (TG-PNI) for the evaluation of pain relief in patients with PN.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique. Methods: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart. Results: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both "pain in the sitting position" and "pain in the region from the anus to the clitoris. " The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both "pain in the sitting position" and "pain in the region from the anus to the clitoris. " The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P > 0.05). Conclusions: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…The posterior approach has been used in recent years in proximal nerve entrapment syndrome, with a high rate of success in terms of the diagnostic/therapeutic objective, although with a moderate 21.7% risk of sacral plexus blockade. 2 Techniques for pudendal nerve blocks described include: 1. anatomical landmarks 15 ; 2. neurostimulation 6,66 ; 3. fluoroscopy 49 ; 4. tomography [67][68][69] ; and, more recently, blockage guided by ultrasound. 1,7,49,59,[70][71][72] We believe that ultrasound is better than other techniques in terms of practical use and results 71 and, therefore, we will focus on the sonoanatomic descriptions that enable a refined and reproducible practice in order to increase the frequency of success in terms on the specific goals proposed for each individual patient.…”

Section: Pudendal Nerve Anatomymentioning

confidence: 99%

“…14 Moreover it is an integral part of the diagnosis and therapy of pudendal neuropathy of which little is known, although there is growing research into its pathophysiology and therapeutic approaches. 2,[14][15][16][17][18][19][20] Despite the above, pudendal nerve blocks are not a popular technique in daily practice in general, urologic or obstetric surgery, perhaps because of lack of knowledge of the block or because of the frequency of blind blocks with variable or incomplete results. 8 At present, with the popularity of ultrasound-guided blocks [21][22][23][24][25][26][27][28][29][30][31][32] it is important to review the anatomy, sonoanatomy and some relevant technical aspects that may make its implementation a safe and reproducible practice.…”

Section: Introductionmentioning

confidence: 99%

Regional anesthesia guided by ultrasound in the pudendal nerve territory☆

Rojas-Gómez

Blanco-Dávila

Roa

et al. 2017

Colombian Journal of Anesthesiology

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Introduction: Pudendal nerve blocks have a wide range of clinical applications for the management of acute post-operative pain in urologic, gynecological surgery, in coloproctology, as well as in pain medicine for differential diagnosis, and for the management of pudendal neuropathies. However, despite its benefits it is infrequently used.Objective: To perform a detailed description of the most recent ultrasound-guided techniques with the aim of encouraging safe and reproducible learning. Materials and methods:We have performed a broad, non-systematic review of the literature through Medline, Embase and Science Direct between 1985 and 2016, to evaluate the most relevant articles, using the following key words: pudendal nerve anatomy, pudendal nerve, pudendal nerve blocks, pudendal nerve ultrasound, pudendal neuralgia, nerve entrapment, chronic pain, Alcock canal, and pelvic pain. The search was limited to articles published in Spanish, English and French.Results: Recent descriptions were found of a large number of anatomic variants, which are described in detail and shown in graphic documents in order to facilitate the sonoanatomic correlation of nerve location as a guide for the performance of the pudendal nerve block through the different approaches.

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“…Different routes of injections, and various types of image-guided pudendal nerve injection (PNI) techniques, which intend to in ltrate local anesthetic agents within proximity to the corresponding nerve, were described previously [14][15][16][17][18][19]. Recently, our pelvic pain workgroup reported that nger-guided transvaginal PNI might be an alternative approach to the ultrasound-guided technique, as a safe and effective treatment for PN management [15].…”

Section: Introductionmentioning

confidence: 99%

Transvaginal Pudendal Nerve Blocks in Patients With Pudendal Neuralgia: Two-year Follow-up Results

Başol

Kale

Gürbüz

et al. 2022

Preprint

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Purpose: Pudendal neuralgia (PN) is an extremely painful neuropathy of the pudendal nerve resulting in a negative impact on a patient's quality of life. The aim of this study is to evaluate the 2-years outcomes of repetitive doses of the transvaginal pudendal nerve injections (PNI) and to compare the success of the PNI concerning anatomical levels (endopelvic and extrapelvic portion) of the pudendal nerve pathology.Methods: This retrospective longitudinal cohort study consists of patients with PN diagnosed with the first four essential Nantes criteria. Diagnostic PNI was performed on 67 patients to fulfill the fifth criteria of Nantes. After the drop-outs, further analyses were carried out with a total of 56 patients.Results: The efficacy of the PNIs significantly declined over time. Pudendal nerve blocks provided a significant decrease in pain scores; however, this decrease lost its strength significantly in the 24th month. The intervention was more effective in entrapments of the pudendal nerve between sacrospinous and sacrotuberous ligaments or below (Level-2) when compared to the injuries in the endopelvic part (Level-1). More than 50% pain reduction continued in five patients with pathology at Level-1 and 24 patients with pathology at Level-2. Conclusion: Repeated PNIs could provide a significant decrease in pain scores for both short and long-term periods. However, the efficacy of the PNIs declined over two years. The success of PNIs may be affected by the anatomical level of the nerve injury; therefore, interligamentous pudendal nerve entrapment cases have more benefits than the cases of pudendal nerve entrapment in the endopelvic part. However, it is recommended to perform therapeutic nerve blocks even in patients with suspected endopelvic pudendal nerve pathology before the referral to surgery.

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New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

Abstract: Perineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.

Cited by 11 publications

References 22 publications

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

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

Regional anesthesia guided by ultrasound in the pudendal nerve territory☆

Transvaginal Pudendal Nerve Blocks in Patients With Pudendal Neuralgia: Two-year Follow-up Results

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