Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal

Bendtsen, Thomas Fichtner; Parras, Teresa; Moriggl, Bernhard; Chan, Vincent; Lundby, Lilli; Buntzen, Steen; Dalgaard, Karoline; Brandsborg, Birgitte; Børglum, Jens

doi:10.1097/aap.0000000000000355

Cited by 55 publications

(44 citation statements)

References 17 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 superficial branch of the prineal nerve innervates the skin of the posterior part of the scrotum/labia majora. The pelvic floor muscles itself—levator ani and coccygeus muscles—are innervated by direct branches of the sacral plexus and by the coccygeal plexus, respectively …”

Section: Resultsmentioning

confidence: 99%

“…The pelvic floor muscles itself-levator ani and coccygeus muscles-are innervated by direct branches of the sacral plexus and by the coccygeal plexus, respectively. 16…”

Section: Normal Topographic Anatomy Of the Pnmentioning

confidence: 99%

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study

Konschake

Brenner

Moriggl

et al. 2016

Neurourology and Urodynamics

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AIMS:The aim was to develop a new laparoscopic technique for placement of a pudendal lead. METHODS: Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis.Stepby-step documentation and analysis of the laparoscopic approach in order to locate the PN directly in its course around the medial part of the sacrospinous ligament and test this approach for feasibility. Landmarks for intraoperative navigation towards the PN as well as the possible position of an lead were selected and demonstrated. RESULTS: The visible medial umbilical fold, the intrapelvine part of the internal pudendal artery, the coccygeus muscle and the sacrospinous ligament are the main landmarks. The PN traverses the medial part of the sacrospinous ligament dorsally, medially to the internal pudendal artery. The medial part of the sacrospinous ligament has to be exposed in order to display the nerve. An lead can be placed ventrally on the nerve or around it, depending on the lead type or shape. CONCLUSIONS: A precise and reliable identification of the PN by means of laparoscopy is feasible with an easy four-step approach: (1) identification of the medial umbilical fold; (2) identification of the internal iliac artery; (3) identification of the internal pudendal artery and incision of the coccygeus muscle ('white line', arcuated line); and (4) exposition of the medial part of the sacrospinous ligament to display the PN. K E Y W O R D Sinternal pudendal artery, laparoscopic approach, medial umbilical fold, neuromodulation, pudendal nerve, sacrospinous ligament

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“…This type of headache can be a debilitating condition for patients that are drug‐resistant and may be caused by peripheral mechanisms of nerve compression in the head region (Kung et al, ). In addition to IONM, ultrasonography is applied on peripheral nerves to address these and other clinical problems (Kessler et al, ; Bendtsen et al, ).…”

Section: Application Of Ionm and Ultrasonography In Thyroid Surgerymentioning

confidence: 99%

Peripheral Nerve Anatomy Revisited: Modern Requirements for Neuroimaging and Microsurgery

Konschake

Burger

Zwierzina

2019

The Anatomical Record

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Detailed anatomic investigation of peripheral nerve topography underlies the correct application of intraoperative neuromonitoring (IONM) and ultrasonography, both well-established methods to prevent nerve palsy during surgical operations and to elucidate pathomechanisms in disease. In this study, we analyzed the anatomy of selected peripheral nerves in the head and neck regions to improve the outcome of endocrine and migraine surgeries. Anatomic dissections of 204 hemilarynges were performed to study the topography of the inferior laryngeal nerve (ILN). Measurements were taken from the lower rim of the cricoid and from the Zuckerkandl tubercle to the beginning of the furcation of the ILN. For the analysis of peripheral nerves contributing to migraine pathogenesis, 22 hemifaces were investigated by dissection and ultrasonography. The supratrochlear and supraorbital nerves and their relationship to the corrugator supercilii muscle are described. For identification of the ILN, the cricoid offers a suitable intraoperative landmark. A single branch existed in 5% of specimens on the left side and in 3% on the right side. Bifurcation was present in 72.5% and 62% and trifurcation in 18% and 29% of cases, respectively. IONM signals from the vagus nerve were positive if derived proximal to and negative if derived distal to the branching off of a nonrecurrent ILN (nrILN). By ultrasonographic identification of a brachiocephalic trunk, an nrILN could be excluded. For migraine surgery, possible compression points of the supratrochlear and supraorbital nerves were identified, and a workflow algorithm for ultrasound visualization of these nerves is provided. Anat Rec, 302:1325-1332, 2019.

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Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal

Cited by 55 publications

References 17 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?

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study

Peripheral Nerve Anatomy Revisited: Modern Requirements for Neuroimaging and Microsurgery

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