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
Laparoscopic Dissection of Obturator Nerve for Obturator Neuralgia after Paravaginal Repair
