Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double-blind, controlled trial.

OBJECTIVE

To compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment.

DESIGN

Randomised, double-blind, controlled trial.

SETTING

Multicentre study.

POPULATION

201 patients were included in the study, with a subgroup of 122 women.

METHODS

CT-guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A (n = 68) had local anaesthetic alone, those in Arm B (n = 66) had local anaesthetic plus corticosteroid and those in Arm C (n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline.

MAIN OUTCOME MEASURES

The primary end-point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30-point improvement on a 100-point visual analogue scale of mean maximum pain over a 2-week period) or nonresponders.

RESULTS

Three months' postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant (P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C (P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality-of-life criteria.

CONCLUSIONS

Corticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used.

TWEETABLE ABSTRACT

Steroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.