Pudendal Nerve Blocks: An Introduction and How-to Guide

Abstract

<h3>Study Objective</h3> To provide a stepwise description of the anatomy, evidence, and technique for performing pudendal nerve blocks for the treatment of pudendal neuralgia. <h3>Design</h3> Video demonstration with narrated description. <h3>Setting</h3> Academic tertiary care site. <h3>Patients or Participants</h3> Patients with pudendal neuralgia. <h3>Interventions</h3> Digital transvaginal pudendal nerve blocks and blocks of the terminal peripheral branches of the pudendal nerve, including the perineal and dorsal clitoral branches. <h3>Measurements and Main Results</h3> Pudendal neuralgia can be identified using the Nantes criteria, which includes pain in the distribution of the pudendal nerve, increased pain with sitting, not being awakened by pain, lack of sensory loss, and resolution of pain after pudendal nerve block. Pudendal nerve blocks have been shown to provide relief in over 75% of patients with pudendal neuralgia, with relief potentially lasting from days to months post-procedurally. This video presents both a transvaginal digital approach to pudendal nerve block as well as targeted blocks of the peripheral branches of the pudendal nerve, including the perineal and dorsal clitoral branches. A review of the relevant clinical anatomy, benefits and risks of the procedures, type and toxicity of injectate medications, procedural set up, procedural techniques, and post-procedural follow up care is presented. <h3>Conclusion</h3> Pudendal nerve blocks, when performed through a safe and standardized approach, are a beneficial therapeutic tool for clinicians caring for patients with pudendal neuralgia.