Mark Daniel Mamlouk MD, Presenter: Nothing to Disclose

Eric vanSonnenberg MD, Abstract Co-Author: Nothing to Disclose

Seena Dehkharghani MD, Abstract Co-Author: Nothing to Disclose

To determine if CT-guided nerve block can diagnose and treat pudendal neuralgia (PN), a poorly understood clinical entity. If so, no further treatment would be necessary in patients (pts) with complete response, while appropriate diagnosis and therapy would be administered to those with partial or no response.

IRB approval was obtained. Over a 1-year period, 50 pts (47 women, 3 men; age range 22-80 yrs) who suffered from chronic pelvic pain with a presumed diagnosis of PN were referred to IR. Pre- and post-procedure pain scores (0-10) were tallied and assessed by t-tests. A P value < .05 was indicative of a significant difference. CT-guided nerve blocks were performed on all pts with the needle targeted towards the pelvic Alcock’s canal. 5 ml of marcaine 1% with 2 ml of kenalog 80 mg were injected once correct needle position was verified by contrast injection into the canal. During follow-up (mean 6 months), if there was resolution of pain, no further blocks were done. If pain recurred, additional sessions were done. A total of 70 procedures were performed for the 50 pts. Simultaneous bilateral blocks were done in 6 pts. 14 pts had 2 sessions, 6 pts had 3, and 1 pt had 4. Pre- and post pain scores are available in 31 pts (52 procedures). If there was initial response to the block(s), followed by pain recurrence, this was considered diagnostic for PN and prompted surgery for nerve release.

All 70 procedures in the 50 pts were successful technically, defined by contrast filling Alcock’s canal, with subsequent infusion of anesthetic/steroids. No immediate or delayed complications ensued. Pre-procedure pain scores for 31 pts (52 procedures) ranged from 2-10 (mean 6.13) and post scores ranged from 0-10 (mean 2.14) and the difference was statistically significant (P < .001). P values for each of the 3 sessions also were significant (<.001, <.001, .049). 14/31 pts had subsequent surgery based on initial improvement with the nerve block, and all 14 pts improved with surgical nerve release. 2 pts each were cured and had no response (alternative diagnoses), respectively.

Our results suggest that CT-guided pudendal nerve blocks can aid in the diagnosis of PN and occasionally in the therapy.

CT-guided pudendal nerve blocks can diagnose and occasionally treat PN. This safe procedure is instrumental in directing clinical management.

Mamlouk, M, vanSonnenberg, E, Dehkharghani, S, CT-guided Nerve Block for Pudendal Neuralgia: Diagnostic and Therapeutic Implications.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003002.html