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REVIEW ARTICLE
Year : 2021  |  Volume : 35  |  Issue : 3  |  Page : 195-202

Redefining the efficacy of USG-Guided pudendal nerve block in pudendal neuralgia in the vulnerable section of the society


Department of Anaesthesiology, Pain Medicine and Critical Care, GTB Hospital and UCMS College, Delhi, India

Correspondence Address:
Dr. Suman Choudhary
Senior Resident, Department of Anaesthesiology, Pain Medicine and Critical Care, GTB Hospital and UCMS College, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_124_20

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Regional anesthetic blocks play a significant role not only in perioperative management but also in the holistic management of chronic intractable pain including cancer pain. Pudendal neuralgia can hamper daily life functions such as sitting, standing and sexual functions thus affecting patient's quality of life. Pudendal nerve arises from ventral divisions of S2,3,4. The nerve lies medial to the internal pudendal vessels at the level of ischial spine and is accompanied by the internal pudendal artery through the lesser sciatic foramen into the pudendal (Alcock's) canal. Pudendal Nerve is 80% sensory and 20% motor. Techniques are dependable on the precise identification of important anatomic landmark structures positioned in the close proximity of the pudendal nerve. These techniques are nerve stimulator guided, Conventional C-arm fluoroscopy guided, CT guided, Ultrasound-guided and latest being ultrasound guided accompanied with Pulsed radiofrequency. Pudendal nerve block may be performed through one the approaches: Anterior/perineal or Posterior/trans gluteal. It has got important role to play in acute and chronic perineal pain which is frequently encountered after gynecologic surgery, obstetric surgery, urologic surgery and gastrointestinal surgery. Ultrasound guided pudendal nerve block has advantages such as no radiation exposure, real time needle insertion guidance with the visualization of spread of local anesthesia. It helps to visualize not only bony structures but also vascular structures, ligaments (interspinous ligament) as well as soft tissues. However, since a lot many multi-institutional trails are needed to conducted to explore the efficacy and safety of ultrasound guided blocks for chronic pelvic pain, as it happens to be highly challenging condition to manage.


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