Obturator Nerve Block for Management of Chronic Pelvic Pain

Abstract

Every year, thousands of women undergo surgeries to treat severe female pelvic organ prolapse or stress urinary incontinence. Unfortunately, chronic pelvic pain may result from these surgical interventions, especially if mesh was used. This case report describes the management of 2 patients that presented at an outpatient pain center with chronic pelvic pain secondary to obturator neuralgia. The first patient was a 45-year-old with history of vaginal reconstruction surgery, who presented to the pain clinic with severe pain in the medial thigh radiating to the perineal area. This pain had been present for months and persisted despite use of oral opioids, neuropathic pain medications, and topical agents. The patient had been seen and evaluated by neurology and urogynecology post operatively, but they could not ascertain the cause of her chronic complaints. The second patient was a 47-year-old with pain in the medial thigh and left side of her groin after transobturator sling procedure. Her pain was resistant to oral neuropathic pain medications (gabapentin and pregabalin) primarily due to the patient’s inability to tolerate therapeutic doses of these medications. She was referred to neurology and nerve conduction studies was notable for decreased conduction in the left obturator nerve. Both patients chose to try ultrasound guided obturator nerve blocks as a diagnostic and treatment modality. After the injection, the patients endorsed significant relief of their pain that persisted through their 3 month follow-up appointments leading to improved functionality in many aspects of their daily lives. In a clinical situation like the one described above, the pain practitioner should more readily consider use of these blocks in the outpatient setting for pelvic pain patients whose symptoms are suggestive of obturator neuralgia. Key words: Chronic pelvic pain, obturator nerve block, mesh pain, obturator neuralgia