Abstract
The autonomic sympathetic nervous system conveys nociceptive messages from the viscera to the brain. The purpose of this article is to review the place of autonomic nerve blocks in the management of chronic pelvic and perineal pain. A comprehensive review of the literature was performed by searching PubMed for articles on autonomic nerve blocks and related procedures in the management of chronic pelvic and perineal pain. Intervention on the sympathetic nervous system for the management of chronic pelvic and perineal pain has been proposed at main three levels: ganglion Impar, hypogastric plexus and L2 lumbar sympathetic blocks. Infiltration of the sympathetic nervous system with local anaesthetic constitutes a diagnostic test by providing pain relief for the duration of action of the local anaesthetic in two third of patients. Specific procedures have been performed such as alcohol nerve block, radiofrequency ablation, surgical section or botulinum toxin infiltration at these various sites to achieve more lasting results. A sympathetic nervous system test block plays a diagnostic role in the management of chronic pelvic and perineal pain by guiding more specific global pain management procedures.
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