Presented at the 2013 AAPM Annual Meeting « Back

A Retrospective Review of Role of Pudendal Nerve Blocks in Management of Chronic Pelvic and Urogenital Pain

Hung Ling Tan, MD M Med (Anaes), linghungtan@hotmail.com¹, Anuj Bhatia, MBBS MD FRCA FRCPC FIPP EDRA¹, Allan S. Gordon, MD FRCP(C) ², (1) Toronto Western Hospital, Toronto, Ontario, Canada, (2) Mount Sinai Hospital, Toronto, Ontario, Canada

Introduction: Pudendal neuralgia can be an etiology for chronic pelvic and urogenital pain (CPUP) although its contribution to the pathophysiology of CPUP is not known. Pudendal nerve blocks with local anesthetic and steroid, using fluoroscopy or ultrasound imaging, are often performed to diagnose and treat pudendal neuralgia. The rationale for this intervention is to reduce perineural inflammation and edema, thereby alleviating pain. There is a lack of data about characteristics of patients with CPUP who are likely to respond to pudendal nerve blocks. This retrospective review aims to gather information and stratify this intervention for patients likely to benefit from this procedure. Materials and Methods: Research ethics board approval was obtained prior to commencing the study. Data from all the patients at our hospital who were diagnosed as having CPUP and received pudendal nerve blocks from January 1st, 2009 till July 31st, 2012 was included. A total of about 150 cases of pudendal nerve blocks involving about 110 patients were reviewed. Data reviewed include demographics, clinical presentation of CPUP and risk factors, present or past treatment, response to pudendal nerve blocks and surgical decompression or neurectomy following positive response to pudendal nerve block. This will be followed by statistical analysis and data interpretation. Results: Data collection is in progress. The study will be completed by February 2013. Conclusion: Appropriate patient selection for pudendal nerve block to treat chronic pelvic and urogenital pain may increase the success rate of this intervention. References: 1) Rofaeel A, Peng PWH, Louis I, Chan V. Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain. Regional Anesthesia and Pain Medicine. 2008; 33:139-145. 2) Peng PWH, Antolak Jr SJ, Gordon AS. Pudendal neuralgia. In: Goldstein A, Pukall CF, Goldstein I, eds. Female sexual pain disorders. Chichester, UK: Wiley-Blackwell, 2009:112-8 3) Vancaillie T, Eggermont J, Armstrong G, Jarvis S, Liu J, Beg N. Response to pudendal nerve block in women with pudendal neuralgia. Pain Medicine. 2012; 13:596-603.

Funding: None