Response to pudendal nerve block in women with pudendal neuralgia.

OBJECTIVE: To examine the evolution of pain and the duration of numbness after neural blockade of the pudendal nerve in women with pudendal neuralgia and correlate with clinical and historical data. DESIGN: Prospective, single arm, open label study. SETTING: University hospital and outpatient clinic. SUBJECTS: Eighty-two adult female patients were recruited from November 8, 2008 to February 14, 2010. Patients were selected based on the presence of spontaneous or provoked pain in the distribution of the pudendal nerve. INTERVENTIONS: Subjects underwent a standardized pudendal nerve block. OUTCOME MEASURES: Visual analog pain scores and the presence of numbness were recorded before and for 64 hours after the pudendal nerve block. A complete clinical history and examination were documented. RESULTS: Sixty-six patients completed the study. About 86.9% had a reduction in one or more pain symptom, while 44.3% found that more than one of their pain symptoms did not return. About 69.7% of patients reported numbness lasting up to 16 hours or longer. Previous gynecological surgery was recorded in 75.8%, previous traumatic obstetric events in 47.0% of cases. Prolonged history of pain correlated with a reduced chance of positive outcome of the pudendal nerve block. CONCLUSION: In patients with pudendal neuralgia, the pudendal nerve block has a variable response, but may have a beneficial effect in a subset of women. Surgical and obstetrical trauma are common historical antecedents.

Lignocaine gel in minimally invasive surgery - A pilot cohort study.

BACKGROUND: The administration of local anaesthetic at the conclusion of minimally invasive procedures has been shown to reduce postoperative pain. However, it is often not feasible to reach target surgical sites using a needle, making it difficult to administer injectable local anaesthetic. Formulations currently available for topical use are also not sterile, adhere poorly, and are not adjusted to neutral pH at the time of use. To address these limitations, a new sterile, aqueous 4.8% lignocaine gel was formulated for topical application on surgical wounds. AIMS: To determine the clinical feasibility, safety and tolerability of the topical lignocaine gel. METHODS: A total of 125 female patients underwent minimally invasive gynaecological procedures. The lignocaine gel was applied to any intra-abdominal, intra-uterine or intra-vaginal surgical wounds. The incidence of any intra- or postoperative complications was determined via retrospective review of surgical reports, hospital files and outpatient clinic files. RESULTS: In all cases, the surgeon was able to apply the gel successfully to the desired site. There were no intra-operative complications. There were no adverse events encountered during recovery or hospitalisation which are likely to be associated with the lignocaine gel. Eight patients experienced adverse events during the postoperative period which could be linked to the use of the gel. However, the incidence of these was within the known range of adverse events for these procedures. CONCLUSIONS: A sterile lignocaine gel can be safely used in minimally invasive surgery.