Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital Mimar Sinan Mh, Emniyet Cd., 16310, Bursa, Turkey.
Arch Gynecol Obstet. 2022 Oct;306(4):1107-1116. doi: 10.1007/s00404-022-06621-1. Epub 2022 May 28.
Pudendal neuralgia (PN) is an extremely painful neuropathy of the pudendal nerve resulting in a negative impact on a patient's quality of life. The aim of this study is to evaluate the 2-year outcomes of repetitive doses of the transvaginal pudendal nerve injections (PNI), and to compare the success of the PNI concerning anatomical levels (endopelvic and extrapelvic portion) of the pudendal nerve pathology.
This retrospective longitudinal cohort study consists of patients with PN diagnosed with the first four essential Nantes criteria. Diagnostic PNI was performed on 67 patients to fulfill the fifth criteria of Nantes. A total of 56 patients who responded to the initial diagnostic PNI underwent therapeutic repeated transvaginal PNIs twice for 3 weeks apart. Mean pain intensity scores were measured using a visual analog scale at the 1st, 3rd, 6th, 12th, and 24th months after the therapeutic blocks were completed. Effectiveness of the PNIs' was defined as ≥ 50% improvement of the initial pain, and relative improvement was defined as 30-50% improvement of the initial pain. Treatment failure was defined as the reduction of the initial pain by less than 30% or the return of the pain to its worst condition.
The efficacy of the PNIs significantly declined over time. Pudendal nerve blocks provided a significant decrease in pain scores; however, this decrease lost its strength significantly in the 24th month. The intervention was more effective in entrapments of the pudendal nerve between sacrospinous and sacrotuberous ligaments or below (Level-2) when compared to the injuries in the endopelvic part (Level-1). More than 50% pain reduction continued in five patients with pathology at Level-1 and 24 patients with pathology at Level-2.
Repeated PNIs could provide a significant decrease in pain scores for both short- and long-term periods. However, the efficacy of the PNIs declined over 2 years. The success of PNIs may be affected by the anatomical level of the nerve injury; therefore, interligamentous pudendal nerve entrapment cases have more benefits than the cases of pudendal nerve entrapment in the endopelvic part. However, it is recommended to perform therapeutic nerve blocks even in patients with suspected endopelvic pudendal nerve pathology before the referral to surgery.
阴部神经痛（PN）是一种极其痛苦的阴部神经病变，会对患者的生活质量产生负面影响。本研究的目的是评估阴部神经重复注射（PNI）的 2 年结果，并比较 PNI 在阴部神经病变的解剖学水平（盆内和盆外部分）方面的成功率。
这项回顾性纵向队列研究包括根据第一个四项必需的南特标准诊断为 PN 的患者。对 67 名患者进行诊断性 PNI，以满足南特的第五项标准。对 56 名对初始诊断性 PNI 有反应的患者进行了 3 周间隔的两次治疗性重复经阴道 PNI。在治疗性阻断完成后的第 1、3、6、12 和 24 个月，使用视觉模拟评分法测量平均疼痛强度评分。PNI 的有效性定义为初始疼痛减轻≥50%，相对改善定义为初始疼痛减轻 30-50%。治疗失败定义为初始疼痛减轻小于 30%或疼痛恢复到最严重状态。
PNI 的疗效随时间推移而显著下降。阴部神经阻滞可显著降低疼痛评分；然而，在第 24 个月，这种降低的强度显著丧失。与盆内部分（第 1 级）相比，阴部神经在骶棘韧带和骶结节韧带之间或以下（第 2 级）的卡压时，干预效果更明显。在第 1 级和第 2 级病变患者中，5 例疼痛减轻超过 50%，24 例疼痛减轻超过 50%。
重复 PNI 可在短期和长期内显著降低疼痛评分。然而，PNI 的疗效在 2 年内下降。PNI 的成功可能受到神经损伤解剖学水平的影响；因此，阴部神经在韧带间卡压的病例比阴部神经在盆内部分卡压的病例获益更多。然而，建议在转诊手术前，即使对疑似盆内阴部神经病变的患者，也应进行治疗性神经阻滞。
