Rigaud J, Riant T, Delavierre D, Sibert L, Labat J-J
Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Prog Urol. 2010 Nov;20(12):1072-83. doi: 10.1016/j.purol.2010.08.053. Epub 2010 Oct 20.
Chronic pelvic and perineal pain can be related to a nerve lesion caused by direct or indirect trauma or by an entrapment syndrome, which must then be demonstrated by a test block. The purpose of this article is to review the techniques and modalities of somatic nerve block in the management of chronic pelvic and perineal pain.
A review of the literature was performed by searching PubMed for articles on somatic nerve infiltrations in the management of chronic pelvic and perineal pain.
Nerves involved in pelvic and perineal pain are: thoracolumbar nerves (obturator, ilioinguinal, iliohypogastric and genitofemoral) and sacral nerves (pudendal and inferior cluneal branches of the posterior cutaneous nerve of the thigh). Infiltration has a dual objective: to confirm the diagnostic hypothesis by anaesthetic block and to try to relieve pain. Evaluation of the severity and site of the pain before and immediately after the test block is essential for interpretation of the block. The various infiltration techniques for each nerve are described together with their respective advantages, disadvantages and risk of complications.
Somatic nerve blocks are an integral part of the management of chronic pelvic and perineal pain and are predominantly performed under CT guidance in order to be as selective as possible. Once the diagnosis and the level of the nerve lesion have been defined, more specific therapeutic procedures can then be proposed.
慢性盆腔和会阴疼痛可能与直接或间接创伤或卡压综合征引起的神经损伤有关，这种损伤必须通过试验性阻滞来证实。本文旨在综述躯体神经阻滞在慢性盆腔和会阴疼痛管理中的技术和方式。
通过在PubMed上搜索关于躯体神经浸润在慢性盆腔和会阴疼痛管理中的文章来进行文献综述。
涉及盆腔和会阴疼痛的神经有：胸腰神经（闭孔神经、髂腹股沟神经、髂腹下神经和生殖股神经）和骶神经（阴部神经和股后皮神经的臀下分支）。浸润有双重目的：通过麻醉阻滞来证实诊断假设，并试图缓解疼痛。在试验性阻滞前后对疼痛的严重程度和部位进行评估对于解释阻滞结果至关重要。文中描述了每条神经的各种浸润技术及其各自的优缺点和并发症风险。
躯体神经阻滞是慢性盆腔和会阴疼痛管理的一个组成部分，主要在CT引导下进行，以便尽可能具有选择性。一旦确定了诊断和神经损伤的部位，就可以提出更具体的治疗方案。
