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Pudendal Peripheral Nerve Block

Pudendal nerve blocks are a minimally invasive, non-surgical treatment for chronic pain. These nerve blocks can help in the diagnosis of chronic pelvic pain conditions such as vaginal pain, penile pain, scrotal pain, or perineal pain. In addition, this pain management technique can also provide therapeutic relief by reducing pain signals originating from these nerves.

The pudendal nerve is prone to damage either by compression or stretch. Common scenarios where this may occur include trauma, prolonged/difficult/traumatic vaginal childbirth, or chronic straining during defecation caused by constipation.

Pudendal nerve entrapment, also known as Alcock canal syndrome, is very rare and is associated with professional cycling. Systemic diseases such as diabetes and multiple sclerosis can also damage the pudendal nerve.

How It Works

A pudendal nerve block is performed with x-ray guidance to increase the accuracy and safety of this procedure. 

  • You will be asked to lie on your stomach. 
  • Your lower back and buttocks will be cleaned with an antiseptic, and a sterile drape will be placed.  
  • Your physician will direct a guide needle toward the intended target area under x-ray guidance. Bony landmarks easily visible under live x-ray guidance will help facilitate safe placement of the needle.
  • A local anesthetic and a steroid (cortisone) will be administered in close proximity to the nerve to block signals from reaching the brain. The cortisone serves as an anti-inflammatory under the assumption the nerve is inflamed or irritated.
  • The needle is then flushed and withdrawn, and a dressing is placed over the point of needle entry.

Risks

This procedure is safe. However, with any procedure, there are side effects, risks, and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, or injection into blood vessels or vital organs. Fortunately, serious side effects and complications are uncommon. X-ray guidance to provide visualization of the targeted structures and landmarks significantly minimizes risk.