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1.
Am J Obstet Gynecol ; 222(1): 70.e1-70.e6, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31319080

RESUMO

BACKGROUND: Pudendal neuralgia is a painful neuropathic condition involving the pudendal nerve dermatome. Tarlov cysts have been reported in the literature as another potential cause of chronic lumbosacral and pelvic pain. Notably, they are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots and it has been postulated that they may cause similar symptoms to pudendal neuralgia. Literature has been inconsistent on the clinical relevance of the cysts and if they are responsible for symptoms. OBJECTIVE: To evaluate the prevalence of S2-S4 Tarlov cysts at the pudendal nerve origin (S2-S4 sacral nerve roots) in patients specifically diagnosed with pudendal neuralgia, and establish association of patient symptoms with location of Tarlov cyst. STUDY DESIGN: A retrospective study was performed on 242 patients with pudendal neuralgia referred for pelvic magnetic resonance imaging from January 2010 to November 2012. Dedicated magnetic resonance imaging review evaluated for presence, level, site, and size of Tarlov cysts. Among those with demonstrable cysts, subsequent imaging data were collected and correlated with the patients' clinical site of symptoms. Statistical analysis was performed using χ2, Pearson χ2, and Fisher exact tests to assess significance. RESULTS: Thirty-nine (16.1%) patients demonstrated at least 1 sacral Tarlov cyst; and of the 38 patients with complete pain records, 31 (81.6%) had a mismatch in findings. A total of 50 Tarlov cysts were identified in the entire patient cohort. The majority of the Tarlov cysts were found at the S2-S3 level (32/50; 64%). Seventeen patients (44.7%) revealed unilateral discordant findings: unilateral symptoms on the opposite side as the Tarlov cyst. In addition, 14 (36.8%) patients were detected with bilateral discordant findings: 11 (28.9%) had bilateral symptoms with a unilateral Tarlov cyst, and 3 (7.9%) had unilateral symptoms with bilateral cysts. Concordant findings were only demonstrated in 7 patients (18.4%). No significant association was found between cyst size and pain laterality (P = .161), cyst volume and pain location (P = .546), or cyst size and unilateral vs bilateral pain (P = .997). CONCLUSION: The increased prevalence of Tarlov cysts is likely not the etiology of pudendal neuralgia, yet both could be due to similar pathogenesis from part of a focal or generalized condition.


Assuntos
Nervo Pudendo/diagnóstico por imagem , Neuralgia do Pudendo/epidemiologia , Raízes Nervosas Espinhais/diagnóstico por imagem , Cistos de Tarlov/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuralgia do Pudendo/diagnóstico por imagem , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Cistos de Tarlov/diagnóstico por imagem , Adulto Jovem
2.
Pain Physician ; 22(4): E333-E344, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337177

RESUMO

BACKGROUND: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain. OBJECTIVE: The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia. STUDY DESIGN: This study used a retrospective cross-sectional study design. SETTING: The research was conducted at a large academic hospital. METHODS: Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed. INTERVENTION: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale. MEASUREMENT: MRN findings for pudendal neuropathy were compared to the results of the CT-guided pudendal nerve blocks. Injection pain responses were categorized into 3 groups - positive block, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC). RESULTS: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02). LIMITATIONS: Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review. CONCLUSION: Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men. KEY WORDS: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy.


Assuntos
Bloqueio Nervoso/métodos , Neuralgia do Pudendo/diagnóstico , Neuralgia do Pudendo/tratamento farmacológico , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/efeitos dos fármacos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
3.
Acta Radiol ; 59(8): 932-938, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29065701

RESUMO

Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Pós-Parto/terapia , Adulto , Angiografia , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/fisiopatologia , Feminino , Genitália Feminina/irrigação sanguínea , Genitália Feminina/diagnóstico por imagem , Genitália Feminina/fisiopatologia , Humanos , Hemorragia Pós-Parto/diagnóstico por imagem , Nervo Pudendo/irrigação sanguínea , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/fisiopatologia , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Reto/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Adulto Jovem
4.
Paediatr Anaesth ; 28(1): 53-58, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29205687

RESUMO

BACKGROUND: Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. AIMS: The first goal of this study was to describe this new technique and to test its feasibility. The second objective was to evaluate intra operative effectiveness and postoperative pain control. METHODS: After parental and children consent, this prospective descriptive study included children aged 1-15 years, ASA status I-III, scheduled for general anesthesia associated with bilateral pudendal nerve block for an elective perineal surgery. After standardized general anesthesia, the anesthesiologist performed pudendal nerve block under ultrasound guidance with "out of plane" approach and evaluated the visualization of anatomical structures (ischial tuberosity, rectum, and pudendal artery), of the needle and of the local anesthetic spread. Pudendal nerve block failure was defined as an increase in mean arterial blood pressure or heart rate more than 20% compared to baseline values after surgical incision. In the postoperative period, the need for rescue analgesia was noted. RESULTS: During the study period, 120 blocks were performed in 60 patients, including 59 boys. Quality of the ultrasonographic image was good in 81% of blocks, with easy visualization of ischium and rectum in more than 95% of cases. Localization of the tip of the needle was possible for all pudendal nerve blocks, directly or indirectly. The spread of local anesthetic was seen in 79% of cases. The block was effective in 88% of cases. CONCLUSION: The new technique of ultrasound-guided pudendal nerve block, described in this study, seems to be easy to perform with a good success rate, and probably improves safety of the puncture and of the injection by real-time visualization of anatomical structures and local anesthetic spread.


Assuntos
Bloqueio Nervoso/métodos , Períneo/diagnóstico por imagem , Nervo Pudendo/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Anestesia Geral , Anestésicos Locais/administração & dosagem , Pressão Sanguínea , Criança , Pré-Escolar , Feminino , Frequência Cardíaca , Humanos , Lactente , Masculino , Agulhas , Dor Pós-Operatória/terapia , Estudos Prospectivos , Reto/diagnóstico por imagem , Ultrassonografia Doppler em Cores
5.
Medicina (B Aires) ; 77(3): 227-232, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28643681

RESUMO

The pudendal nerve entrapment is an entity understudied by diagnosis imaging. Various causes are recognized in relation to difficult labors, rectal, perineal, urological and gynecological surgery, pelvic trauma fracture, bones tumors and compression by tumors or pelvic pseudotumors. Pudendal neuropathy should be clinically suspected, and confirmed by different methods such as electrofisiological testing: evoked potentials, terminal motor latency test and electromyogram, neuronal block and magnetic resonance imaging. The radiologist should be acquainted with the complex anatomy of the pelvic floor, particularly on the path of pudendal nerve studied by magnetic resonance imaging. High resolution magnetic resonance neurography should be used as a complementary diagnostic study along with clinical and electrophysiological examinations in patients with suspected pudendal nerve neuralgia.


Assuntos
Imagem por Ressonância Magnética , Nervo Pudendo/diagnóstico por imagem , Neuralgia do Pudendo/diagnóstico por imagem , Diagnóstico Diferencial , Eletromiografia , Humanos , Neuroimagem/métodos , Nervo Pudendo/anatomia & histologia , Neuralgia do Pudendo/etiologia , Neuralgia do Pudendo/terapia
6.
J Clin Ultrasound ; 45(9): 589-591, 2017 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-28186626

RESUMO

Injury to the penis resulting from zipper entrapment is a painful condition that presents a unique anesthetic challenge to the emergency physician and may even require procedural sedation for removal. In this case report, we describe successful removal of zipper entrapment from the penis of a 34-year-old patient after the application of an ultrasound-guided dorsal penile nerve block. We discuss the anatomy, sonographic features, and steps required for the nerve block procedure. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:589-591, 2017.


Assuntos
Prepúcio do Pênis/diagnóstico por imagem , Prepúcio do Pênis/lesões , Bloqueio Nervoso/métodos , Doenças do Pênis/patologia , Nervo Pudendo/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Anestésicos Locais/administração & dosagem , Antibacterianos/uso terapêutico , Bacitracina/uso terapêutico , Prepúcio do Pênis/patologia , Humanos , Lidocaína/administração & dosagem , Masculino , Necrose , Doenças do Pênis/diagnóstico , Doenças do Pênis/tratamento farmacológico , Pênis/diagnóstico por imagem , Pênis/lesões , Pênis/inervação , Nervo Pudendo/efeitos dos fármacos
7.
Acta Radiol ; 58(6): 726-733, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27664277

RESUMO

Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples.


Assuntos
Imagem por Ressonância Magnética , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Pudendo/diagnóstico por imagem , Humanos , Neuroimagem/métodos , Nervo Pudendo/anatomia & histologia
9.
PLoS One ; 11(11): e0165239, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27828983

RESUMO

Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the sacrotuberous ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9-55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2-3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock's canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4-5 mm) in the group of prior STL division without repair and 8 mm (range, 8-9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal spontaneously and will be significantly thicker after healing.


Assuntos
Descompressão Cirúrgica/métodos , Ligamentos Articulares/cirurgia , Nervo Pudendo/cirurgia , Cicatrização , Adulto , Feminino , Humanos , Imageamento Tridimensional/métodos , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico por imagem , Nervo Pudendo/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
J Neurosurg Spine ; 25(5): 636-639, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27314552

RESUMO

Pudendal nerve schwannomas are very rare, with only two cases reported in the English-language literature. The surgical approaches described in these two case reports are the transgluteal approach and the laparoscopic approach. The authors present the case of a patient with progressive pelvic pain radiating ipsilaterally into her groin, vagina, and rectum, who was subsequently found to have a pudendal schwannoma. The authors used a transischiorectal fossa approach and intraoperative electrophysiological monitoring and successfully excised the tumor. This approach has the advantage of direct access to Alcock's canal with minimal disruption of the pelvic muscles and ligaments. The patient experienced complete relief of her pelvic pain after the procedure.


Assuntos
Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Pudendo/cirurgia , Adulto , Dor do Câncer/diagnóstico por imagem , Dor do Câncer/cirurgia , Feminino , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/fisiopatologia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/fisiopatologia , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/fisiopatologia , Cirurgia Assistida por Computador/métodos
11.
Reg Anesth Pain Med ; 41(2): 140-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26780419

RESUMO

BACKGROUND AND OBJECTIVES: Ultrasound-guided techniques for pudendal nerve block have been described at the level of the ischial spine and transperineally. Theoretically, however, blockade of the pudendal nerve inside Alcock canal with a small local anesthetic volume would minimize the risk of sacral plexus blockade and would anesthetize all 3 branches of the pudendal nerve before they ramify in the ischioanal fossa. This technical report describes a new ultrasound-guided technique to block the pudendal nerve. The technique indicates an easy and effective roadmap to target the pudendal nerve inside the Alcock canal by following the margin of the hip bone sonographically along the greater sciatic notch, the ischial spine, and the lesser sciatic notch. METHODS: The technique was applied bilaterally in 3 patients with chronic perineal pain. The technique described was also used to locate the pudendal nerve within Alcock canal and inject dye bilaterally in 2 cadavers. RESULTS: Complete pinprick anesthesia was obtained in the pudendal territory of the perineum in all 3 patients. Pain was effectively alleviated or reduced in all patients with no affection of the sacral plexus nerve branches. In the 2 cadavers, all 4 pudendal nerves were successfully targeted and colored. CONCLUSIONS: This new technique is based on easily recognizable sonoanatomical patterns. It probably implies no risk of sacral plexus blockade, and the pudendal nerve is anesthetized before any branches ramify from the main trunk. This promising new technique must be validated in future clinical trials.


Assuntos
Dor Crônica/diagnóstico por imagem , Dor Crônica/terapia , Bloqueio Nervoso/métodos , Nervo Pudendo/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Feminino , Humanos , Masculino
12.
Anaesthesist ; 65(2): 134-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26811947

RESUMO

Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain.


Assuntos
Dor Pélvica/diagnóstico por imagem , Dor Pélvica/terapia , Nervo Pudendo/diagnóstico por imagem , Tratamento por Radiofrequência Pulsada/métodos , Adulto , Idoso , Doença Crônica , Cistite/complicações , Cistite/terapia , Feminino , Seguimentos , Humanos , Masculino , Bloqueio Nervoso , Resultado do Tratamento , Ultrassonografia de Intervenção
14.
Clin Neurophysiol ; 125(6): 1278-84, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24368033

RESUMO

OBJECTIVE: To assess if Ultrasound (US) is contributive in patients suspected of having idiopathic pudendal neuralgia. METHODS: Between July 2012 and April 2013, 10 consecutive female patients with suspected idiopathic pudendal neuralgia (mean age: 47±14 years; mean BMI: 24±3) were included. Two radiologists blinded to the clinical and neurophysiological data performed pudendal nerve evaluation with broadband linear array transducers (12-7 MHZ, and 17-5 MHZ). MRI was added to confirm US data. A third independent clinician, who did not perform electrodiagnosis and US, reviewed the data and scored US as "contributive" or "non-contributive": if US confirmed the clinical and neurophysiological diagnosis or if US findings were not useful. RESULTS: Ultrasound identified alterations to the pudendal nerve in 7/10 of cases (70%). In seven cases US revealed the presence of a diffusely or focally enlarged pudendal nerve confirmed by MRI. In these cases neurophysiological findings were suspicious for pudendal neuralgia in 5/7 cases, whereas in 2/7 cases they were inconclusive. CONCLUSION: High-resolution ultrasound (US) may demonstrate alterations to the pudendal nerve in patients with pudendal neuralgia. SIGNIFICANCE: US is useful in patients with suspected idiopathic pudendal nerve disease.


Assuntos
Síndromes de Compressão Nervosa/diagnóstico por imagem , Neuralgia/diagnóstico por imagem , Nervo Pudendo/diagnóstico por imagem , Adulto , Idoso , Eletrodiagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/patologia , Condução Nervosa , Neuralgia/patologia , Neuralgia/fisiopatologia , Postura , Estudos Prospectivos , Nervo Pudendo/patologia , Ultrassonografia
15.
Muscle Nerve ; 47(3): 403-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23180573

RESUMO

INTRODUCTION: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures. METHODS: Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MHZ) and high-frequency (12-7-MHZ and 17-5-MHZ) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility. RESULTS: Visualization of the pudendal nerve at the ischial spine was best when using a medial approach (P < 0.004); the terminal branches were seen best with the anterior approach (P < 0.002). CONCLUSION: High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches.


Assuntos
Nervo Pudendo/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Cadáver , Clitóris/inervação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Plexo Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pênis/inervação , Decúbito Ventral , Reto/inervação , Decúbito Dorsal
16.
Reg Anesth Pain Med ; 37(3): 262-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22430025

RESUMO

BACKGROUND: Although fluoroscopy is an established imaging modality for pudendal nerve block, ultrasound (US) technique allows physicians better visualization of anatomic structures. This study aimed to compare the effectiveness and safety between the US- and fluoroscopy-guided techniques. METHODS: A randomized, single-blind, split-plot design was used to conduct the study. Twenty-three patients undergoing bilateral pudendal nerve blocks received US-guided injections to either the left or right side, whereas the contralateral side received a fluoroscopic-guided injection in randomized sequence. Injections consisted of 4 mL of 0.5% bupivacaine and 40 mg methylprednisone. The primary outcome was the success of the block in the distribution of the pudendal nerve along the perineum, rated as either absent, moderate, or strong. Secondary outcomes were the time to administer the blocks, quality of visualization of anatomic structures using US and fluoroscopy, distance of the final US-guided needle position from the ischial spine, and incidence of adverse effects. RESULTS: No differences in the degree of neural blockade were noted between US- or fluoroscopic-guided techniques for either temperature or pinprick blockade. Time to complete the procedure was significantly longer using US compared with fluoroscopy (219 [SD, 65] and 428 [SD, 151] secs, P < 0.0001). No significant differences were noted regarding the occurrence of adverse effects between the 2 techniques. CONCLUSIONS: Ultrasound-guided pudendal nerve blockade is as accurate as fluoroscopically guided injections when performed by an experienced clinician. However, the former took a longer time to perform.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Períneo/inervação , Nervo Pudendo/diagnóstico por imagem , Radiografia Intervencionista , Ultrassonografia de Intervenção , Distribuição de Qui-Quadrado , Fluoroscopia , Humanos , Injeções , Masculino , Ontário , Limiar da Dor/efeitos dos fármacos , Nervo Pudendo/efeitos dos fármacos , Radiografia Intervencionista/métodos , Método Simples-Cego
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