Educational Exhibit Abstract No. 445 - Feasibility of utilizing CT- guided theraputic pudendal nerve block in treating pudendal neuralgia

Abstract

Detail the indications, benefits, and procedural details of a therapeutic pudendal nerve block. Trauma, compression, or entrapment of the pudendal nerve along its course can produce chronic pelvic and perineal pain. Presenting symptoms can mimic a variety of dermatological, urological, and gynecological conditions making the initial diagnosis challenging. A variety of non-diagnostic tests are typically performed and ineffective treatments are attempted with no relief of patient’s symptoms. Even after a diagnosis is established, conservative treatment with physiotherapy and pharmacotherapy might fail to relief symptoms. Studies have found CT-guided pudendal nerve block to be a quick, safe, and effective procedure to diagnose and treat pudendal neuralgia. A local anesthetic injected adjacent to the nerve can provide immediate relief and subsequent treatments with steroid and or botox can be performed for maintenance therapy. Using CT-guided needle placement, a 26 gauge spinal needle is guided towards the pudendal bundle either between the sacrospinous and sacrotuberious ligaments or in the pudendal canal (Alcock’s canal). The needle tip is positioned adjacent to the pudendal nerve and a long acting local anesthetic, such as bupivacaine is administered. If patient’s symptoms resolve immediately, the procedure is found to be diagnostic for pudendal neuralgia and repeated one week apart for two more times. When the procedure is repeated, a corticosteroid, such as triamcinolone or methylprednisolone, is often administered concurrently for its anti-inflammatory effects. CT-guided pudendal nerve block is a safe and effective treatment for patient's with pudendal neuralgia. The procedure can be performed relatively quick for both diagnostic and therapeutic goals.