Disclosures: Devas J. Modi, DO: No financial relationships or conflicts of interest

Case Diagnosis: We described a revised technique for fluoroscopy guided pudendal nerve blocks for treatment of chronic pelvic pain or pudendal neuralgia.

Case Description: A 27 year old female presented with chronic pelvic pain for greater than 1 year. The pain is described over the pubic symphysis with radiation to the vulva region. She had participated in various treatment options with pharmacotherapy, botox injections, and physical therapy but described no relief. Patient was referred to interventional pain for a pudendal nerve block for diagnostic and therapeutic value.

Setting: Patient was evaluated in an outpatient setting and the procedure was performed in a procedure suite.Assessment/

Results: At the patient’s follow up appointment after 4 weeks, she reported >70% pain relief. Patient was encouraged to continue to participate in a rehabilitation program with focus on strengthening gluteal and hamstring muscles, and Kegel exercises

Discussion: For patients suffering from chronic pelvic pain or pudendal neuralgia, pudendal nerve blocks have shown to have both diagnostic and therapeutic value. Previously done based on anatomical structures, advancements to fluoroscopically guided pudendal nerve blocks have provided more comfort for the patient as sensitive regions are avoided to administer the block. The literature describes fluoroscopic techniques which involves advancing the spinal needle to the tip of the ischial spine. We describe a similar technique under fluoroscopy, with a variation in needle tip placement. Based on MRI imaging and CT guided procedures, the pudendal nerve block was conducted under fluoroscopy, with positioning of the needle tip anterior and medial to the ischial spine. Contrast medium was delivered to confirm placement within Alcock’s canal and subsequent local anesthetic for analgesia.

Conclusion: Fluoroscopy guided pudendal nerve blocks using multiple confirmatory views with the needle positioned anterior and medial to the ischial spine is a safe and effective method of treating chronic pelvic pain or pudendal neuralgia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/technique-for-fluoroscopically-guided-pudendal-nerve-block-for-chronic-pelvic-pain/