Aims and objectives
Our aim is to assess the effectivity of CT-guided pudendal nerve block procedure in cases of suspected pudendal neuralgia (PN) as cause of chronic pelvic floor pain.
Also,
the technical procedure is described.
BACKGROUND
Chronic pelvic pain syndrome refers to pelvic pain with no established local or infectious cause for at least 6 months.
Pudendal neuralgia is a painful neuropathic condition,
involving the dermatome of the pudendal nerve,
first described by Amarenco and colleagues [1] in 1987.
Patients with pudendal neuralgia usually present with burning...
Methods and materials
81 CT-guided pudendal nerve block procedures are performed in 53 women between May 2015 and July 2018 in our Terciary Hospital.
Inclusion criteria:
Chronic pelvic pain with a presumed diagnosis of PN.
>18 years.
Exclusion criteria:
Iodinated contrast allergy.
Previous ineffective blocks by surgery approach.
Removal criteria:
Lack of follow-up (we were not able to follow up on 16 patients).
After removal of those ones with no further follow up,
our final sample was of 37 women (ranging in age from 18 to 78 years)...
Results
Pre- and post- procedural pain scores range from 2 to 10 (mean score 7) and 1 to 8 (mean score 5,4) respectively; the difference was statistically significant (p < 0.05).
In 6 cases a long term (mean 2 months follow-up) symptoms relief was
achieved.
These patients were spared further therapy (repeated nerve blocks or nerve release surgery).
In 12 patients no diagnostic response was recorded,
and the diagnosis of PN was excluded.
Only a minor complication was seen in our serie: a case with postprocedural...
Conclusion
CT-guided pudendal nerve block appears to be a safe and valuable procedure for chronic pelvic floor pain management when PN is suspected,
primarily for the diagnosis and occasionally as therapy.
With the assurance of optimal positioning of the injections for the block in all patients,
referring clinicians felt comfortable assuming that the response to the block either was diagnostic for PN or ruled out PN.
A positive response to the pudendal nerve perineural injection,
even when pain relief was transient and provided diagnostic information only,...
References
Amarenco G,
Lanoe Y,
Perrigot M et al (1987) A new canal syndrome: compression of the pudendal nerve in Alcock’s canal or perinal paralysis of cyclists.
Presse Med.
16(8):399 [in French].
Khoder W,
Hale D (2014) Pudendal neuralgia.
Obstet Gynecol Clin North Am.41(3):443-52.
Mamlouk MD,
vanSonnenberg E,
Dehkharghani S (2014) CT-guided nerve block for pudendal neuralgia: diagnostic and therapeutic implications.
AJR Am J Roentgenol.
203(1):196-200.
Hough DM,
Wittenberg KH,
Pawlina W et al (2003) Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided...