Pudendal Nerve Block - An Overview

What Is a Pudendal Nerve Block?

In order to treat pain and discomfort in the pelvic area, the pudendal nerve is precisely targeted during a medical treatment known as a pudendal nerve block. The pudendal nerve, a significant pelvic nerve, sends signals to the genital and anal regions as well as the perineum (the region between the anus and genitals), supplying those regions with feeling. It is a part of the peripheral nervous system. Pudendal neuralgia can result from compression, trapping, or other types of irritation that harm this nerve. Along with other symptoms, this results in persistent pelvic discomfort.

What Is a Pudendal Nerve Block Used For?

There are three major goals of a pudendal nerve block:

• Diagnosis: The physician may conduct a pudendal nerve block using local anesthetics if one has pelvic discomfort, but they are unsure of its specific cause. If the block relieves one’s pain, the pudendal nerve may be a probable cause of one’s discomfort. If the patient is not experiencing any alleviation, the pain may originate from somewhere else. Pudendal nerve blocks used for diagnosis might assist the physician in formulating a treatment plan.

• Treatment: Pudendal nerve block is utilized by providers to treat pudendal neuralgia-related persistent pelvic discomfort. Local anesthetics are frequently used in this injection, which can also contain corticosteroids.

• Regional Anesthesia: In order to give regional anesthesia for specific gynecologic, obstetrical, and anorectal operations, physicians utilize pudendal nerve blocks. These include hemorrhoidectomies (internal or external hemorrhoids that require significant or severe surgery can be removed), vaginal repairs, and delivery by vaginal birth during the second stage of labor. Pudendal blocks are used for urological treatments less frequently. There are various anesthesia possibilities if the nerve block is unable to relieve pain (analgesia).

How Is a Pudendal Nerve Block Administered?

The method for a pudendal nerve block differs based on the location and goal of the injection by the medical practitioner.

• Transvaginal Approach: For obstetric and gynecological treatments, the transvaginal technique is commonly used.

  • The patient’s legs will be split apart, and the feet will be in high stirrups while the patient will lay on their back on a medical table.

  • To relax, the patient gets a moderate sedative through an IV line in the arm.

  • The healthcare professional will gently feel along the vaginal wall for the ischial spines. This assists them in locating the pudendal nerve.

  • An Iowa Trumpet, which is a needle guide device, will be delicately inserted into the vagina by the healthcare professional. In order to numb the region where the patient will get the nerve block, the practitioner will inject a local anesthetic after guiding the needle through the Iowa trumpet. As the needle enters the vaginal wall, one can feel a pinch or some sort of discomfort.

  • The drug will subsequently be injected as near to the pudendal nerve as feasible. To find the precise location where the injection has to go, the clinician may employ imaging guidance, such as ultrasound or fluoroscopy.

  • If a patient needs a bilateral (both sides) block, the medical professional will repeat this process on the other side of the vagina or pelvic area.

• Transperineal Approach: The transperineal technique is used by medical professionals for urological and anorectal treatments, as well as for pudendal neuralgia in males.

  • The patient has to lie on the back of a specialized table during the test in a medical environment. To give support and stability during the operation, the legs are gently spaced apart, and the feet will be set in high stirrups.

  • To relax, the patient gets a moderate sedative through an IV line in the arm.

  • The perineum will be cleaned with an antiseptic solution by the healthcare professional.

  • A healthcare professional carries out the procedure that entails the delicate insertion of their finger into either the rectum or vagina in order to palpate and find the ischial spine, which marks the position of the pudendal nerve. Alternatively, the medical professional can employ ultrasound imaging to properly pinpoint one’s pudendal nerve while preserving the comfort and dignity all through the procedure.

  • To make the location where the nerve block will be administered pain-free, a local anesthetic will be injected into the patient closer to the area of the pudendal nerve.

  • If the nerve block is needed on both sides, the process is repeated.

• Perirectal Approach: The perirectal technique is most frequently used by healthcare professionals for anorectal treatments and pudendal neuralgia.

  • The patient is made to rest on the side of the medical table, and a sedative is provided to the patient to help them relax through an IV line.

  • The rectal region will be cleaned by the physician using an antiseptic solution.

  • In order to feel the ischial spine, the provider will carefully put their finger into the rectum or vagina with the patient's permission. This assists them in locating the pudendal nerve. To find the pudendal nerve, they could employ electromyography (EMG) and a nerve stimulator. The sphincter contracts as a result of nerve stimulation to the pudendal nerve.

  • Local anesthesia is inserted at the site as close as to the pudendal nerve.

  • The process is repeated if the nerve block has to be repeated on both sides.

What Are the Benefits of Pudendal Nerve Block?

• The pudendal nerves may have a permanent or temporary decrease in inflammation, which might hasten the healing process as well as help the patients to function in a better way.

• Excluding or verifying the pudendal nerve as the cause of pelvic discomfort.

• As a regional anesthetic block, pudendal nerve blocks are often safer than general anesthesia. Regional anesthesia does not have the same hazards associated with general anesthesia, such as cardiopulmonary depression.

The pudendal nerve block is a regional anesthetic block and can provide relief in as little as an hour, while an injection of corticosteroid can take a few days to start working. It is important to realize, though, that pudendal nerve blocks may not always relieve pain. It could be important to look into alternative choices if this treatment does not relieve the symptoms.

What Are the Side Effects of Pudendal Nerve Block?

The most common adverse effect of a pudendal nerve block is pain at the injection site, which usually goes away in a few days. There is a chance of bleeding and infection at the injection site, though these events are less frequent. Some people may feel transient leg weakness and numbness following the treatment since the pudendal nerve and sciatic nerve lie in close proximity to each other. Although rare, serious problems might include:

• A pudendal nerve injury.

• Injury to the rectum or bladder, which are nearby organs that are close to the pudendal nerve.

• Puncturing the pudendal artery while administering local anesthetics. Systemic local anesthetic poisoning, which may be deadly, can result from the pudendal nerve block.

Conclusion

Pudendal nerve blocks may be used to treat persistent pelvic discomfort. The outcomes, however, might differ greatly from person to person. Additionally, they work well as local anesthesia for several pelvic operations. If a patient develops any new symptoms or consequences related to the pudendal nerve block, such as an infection or nerve problems, including searing pain, tingling, or protracted weakness, they should seek medical attention immediately.