Pudendal nerve blocks in men undergoing urethroplasty: a case series

Abstract

The pudendal nerve block (PNB) is widely used for regional anesthesia during obstetric and anorectal procedures, but its role in urologic procedures has not been thoroughly studied. While transvaginal PNB is relatively straightforward, PNB in male patients often requires imaging guidance due to difficulty appreciating anatomic landmarks. We review the PNB and relevant sonoanatomy, and describe its analgesic efficacy in three male patients undergoing urethroplasty for urethral stricture. In this procedure, the patient was placed in lithotomy position, the ischial tuberosity was palpated, and the sacrotuberous ligament and pudendal artery were identified using ultrasound. Ropivacaine was injected medial to the pudendal artery and disappearance of muscle twitch was demonstrated. Two patients reported well-controlled pain at 24 hours postoperatively. One reported perineal pain requiring additional analgesia. All patients were discharged on postoperative day 1 without complications. Ultrasound-guided PNB provides safe and reasonably effective pain control to male patients undergoing urologic procedures.

Narcotic Requirements before and after Implementation of Buccal Nerve Blocks for Buccal Mucosa Graft Harvest: Technique and Retrospective Review

“…In 2017, Kalava et al published a case series describing three patients that underwent pudendal blocks prior to urethroplasty using a trans-perineal approach. None of the three patients required narcotic pain medications while inpatient [ 21 ]. In 2019, Jonnavithula et.…”

Efficacy of Pudendal Nerve Blocks and Ultrasound-Guided Superior Hypogastric Plexus Blocks for the Management of Refractory Interstitial Cystitis: A Case Series

“…A description of the rationale for each procedural technique is provided here. Pudendal nerve blocks via fluoroscopic- [ 11 ], ultrasound- [ 12 ], CT- [ 13 ], and MRI-guided [ 14 ] approaches have been described with varying levels of success. Ultrasound-guided transperineal pudendal nerve blocks in children [ 15 ] seem relatively easy and effective, but in adults, this becomes challenging due to poor tissue penetration with low-frequency ultrasound and the presence of scarring.…”

Pain management strategies in urethral reconstruction: a narrative review

“…Pudendal nerve blocks are routinely performed in women via a transvaginal approach using well-defined anatomic landmarks such as the ischial spines. This nerve block is more technically challenging in men, requiring approaches such as transperineal, transrectal, or transgluteal techniques but have been shown to consistently provide up to 12–18 hours of postoperative analgesia ( 32 ). The performance of pudendal nerve blocks in men depends on surgeon comfort and may require multiple injections.…”