Neuroradiology and MRI unit, Grenoble University Hospital, France; University of Grenoble Alpes, Grenoble Institute des Neurosciences, Inserm, U1216, Grenoble, France.
Cimves Radiology Center, Vesoul, France.
Pain Physician. 2018 Jan;21(1):83-90.
Pudendal neuralgia (PN) is a very painful and often disabling condition in which pudendal nerve blocks play an important role in both the diagnosis and management of PN. Some previous reports have advocated the use of pudendal nerve infiltration (PNI) as a diagnostic test only.
We aim to assess the outcomes of patients with typical refractory PN who underwent dual site computed tomography (CT)-guided pudendal nerve infiltration.
A bicentric, retrospective cohort analysis.
An academic practice.
Between 2002 and 2016, 385 PNIs were performed in 195 patients in the 2 units. Only patients suffering from typical clinical PN were included, and only the first infiltration in each patient was considered for analysis. Therefore, 95 patients who underwent 155 procedures were assessed. Pain was assessed using a visual analog scale (0-10) and self-reported estimated improvement (SRI), expressed as a percentage. Efficacy of the procedure was assessed at 1, 3, and 6 months after procedure follow-up, and clinical success was defined as a 50% decrease of the VAS score. All procedures were performed under CT guidance and on an outpatient basis. Dual site infiltration was performed in each case at both the ischial spine and intra-Alcock's canal sites using a mixture of fast- and slow-acting anesthetic (1 mL lidocaine hydrochloride 1% and 2 mL ropivacaine chlorhydrate) along with a half dose of 1.5 mL of cortivazol (3.75 mg).
Clinical success at one month post-procedure was present in 63.2% of patients (60/95) with a mean VAS score of 2.07 (P < 0.05) and a mean SRI of 71%. At 3 months follow-up, clinical success was still present in 50.5% of patients (48/95) with a mean VAS score of 2.90/10 (P < 0.05) and a mean SRI of 62.3%. At 6 months follow-up, the efficacy rate decreased to 25.2% with a mean VAS score of 3.2/10 and SRI of 60%.
The retrospective aspect of the study is a limitation, as well as the lack of a control group.
Dual site PNI under CT guidance may offer significant mid-term pain relief to a majority of patients suffering from typical refractory PN.
Pudendal nerve, neuralgia, block, Alcock, CT, guidance.
阴部神经痛（PN）是一种非常痛苦且常常致残的疾病，阴部神经阻滞在 PN 的诊断和治疗中都具有重要作用。一些先前的报告主张将阴部神经浸润（PNI）仅用作诊断性检查。
我们旨在评估接受双重部位计算机断层扫描（CT）引导阴部神经浸润的典型难治性 PN 患者的治疗效果。
双中心回顾性队列分析。
学术实践。
2002 年至 2016 年间，在 2 个单位共对 195 名患者进行了 385 次 PNI。仅纳入患有典型临床 PN 的患者，并且仅分析每位患者的第一次浸润。因此，评估了 95 名患者的 155 次手术。疼痛使用视觉模拟量表（0-10）和自我报告的估计改善（SRI）进行评估，以百分比表示。术后 1、3 和 6 个月进行了术后随访，将临床疗效定义为 VAS 评分降低 50%。所有手术均在 CT 引导下在门诊进行。在每个病例中，在坐骨棘和 Alcock 管内均进行了双重部位浸润，使用混合快速和慢速麻醉剂（1 毫升盐酸利多卡因 1%和 2 毫升罗哌卡因盐酸盐），同时使用皮质醇半剂量 1.5 毫升（3.75 毫克）。
术后 1 个月时，63.2%的患者（60/95）临床疗效显著，平均 VAS 评分为 2.07（P<0.05），平均 SRI 为 71%。在 3 个月的随访中，仍有 50.5%的患者（48/95）临床疗效显著，平均 VAS 评分为 2.90/10（P<0.05），平均 SRI 为 62.3%。在 6 个月的随访中，疗效下降至 25.2%，平均 VAS 评分为 3.2/10，SRI 为 60%。
研究的回顾性方面是一个局限性，以及缺乏对照组也是一个局限性。
CT 引导下的双重部位 PNI 可能为大多数患有典型难治性 PN 的患者提供中期疼痛缓解。
阴部神经，神经痛，阻滞，Alcock，CT，引导。
