New, simple, ultrasound-guided infiltration of the pudendal nerve

Abstract Background Blockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock’s canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN. Objective To investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock’s canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience. Subjects Eight Thiel-embalmed cadavers (16 hemipelvises). Methods Three physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock’s canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist. Results The injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock’s canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators. Conclusions US-guided injection of the PN can be performed accurately at both the ischial spine and Alcock’s canal levels. The difference between the approaches was not statistically significant.

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Analgesic effect of bilateral ultrasound-guided pudendal nerve blocks in management of interstitial cystitis

Journal of Anesthesia ◽

10.1007/s00540-011-1243-z ◽

2011 ◽

Vol 26 (1) ◽

pp. 128-129 ◽

Cited By ~ 7

Author(s):

Lyn Li Lean ◽

Dominic Hegarty ◽

Dominic Harmon

Keyword(s):

Interstitial Cystitis ◽

Analgesic Effect ◽

Pudendal Nerve ◽

Ultrasound Guided ◽

Nerve Blocks

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Ultrasound-Guided Pudendal Nerve Block Combined with Propofol Deep Sedation versus Spinal Anesthesia for Hemorrhoidectomy: A Prospective Randomized Study

Pain Research and Management ◽

10.1155/2021/6644262 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Jian He ◽

Lei Zhang ◽

Dong L. Li ◽

Wan Y. He ◽

Qing M. Xiong ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Spinal Anesthesia ◽

Urinary Retention ◽

Nerve Block ◽

Pudendal Nerve ◽

Deep Sedation ◽

Randomized Study ◽

Prospective Randomized Study ◽

Ultrasound Guided

Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan–Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan–Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h ( p < 0.001 ) and during mobilization at 12, 24, 36, and 48 h ( p < 0.001 ) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0–24 h ( p < 0.001 ) and during 24–48 h ( p < 0.001 ) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p = 0.034 ). The patients in Group PNB had higher satisfaction compared to Group SA ( p < 0.001 ). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan–Morgan hemorrhoidectomy.

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