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Pudendal nerve block: technique and its clinical application 2007

Interventional Spine

Sudhir Kathuria, M.D.
Edward Lin, M.D., Non ASSR Member
Per-lennart Westesson, M.D., PhD, Non ASSR Member

Scientific Poster

Exhibit Panels: 2

Purpose

To know the technique and clinical application of pudendal nerve block using illustrations from cases done at our institute.

Methods & Materials

Pudendal nerve entrapment is a pain condition for no apparent reason in the lower central pelvic areas. This is usually precipitated by prolonged sitting or trauma to the sitting area, combined with a genetic and developmental susceptibility. Pudendal nerve entrapment can be frequently misdiagnosed as prostadynia, non bacterial prostatitis, idiopathic vulvodynia, idiopathic orchialgia, idiopathic proctalgia, and idiopathic penile pain syndrome.

Image-guided pudendal nerve block is the most important diagnostic test following history and physical examination for patients with suspected pudendal neuralgia. We present the proper technique of pudendal nerve block and its clinical application based on our experience of various cases done at our institute that were referred to us with clinical suspicion of pudendal neuralgia from wide geographic areas. We followed the protocol of three sequential CT image-guided nerve blocks, first with local anesthetics at ischial spine, followed by local anesthetic at the level of alcock's canal and later possibly combined with corticosteroids.

Results

Pudendal nerve can be easily identified in all cases using cross sectional CT image and pudendal nerve block can be successfully obtained under CT guidance. Pudendal nerve block is relatively quick and useful procedure that can be done safely under CT guidance. The nerve anatomy and procedure steps will be illustrated in the final presentation.

Conclusion

Pudendal nerve block, along with clinical and physical examination, is an important and effective tool in the diagnosis of pudendal nerve entrapment. The procedure requires the knowledge of cross sectional nerve anatomy and can be safely performed under CT guidance.

Images

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