The pudental nerve innervates the perineum and external genitalia. Cases of neuropathic pain at this location are often due to compression of this nerve as well as the inferior cluneal nerves, branches of the posterior cutaneous nerve of thigh. Differences in location and character of pain guide the differential diagnosis.
Diagnostic-therapeutic blocks of these nerves have been performed under ultrasound guidance in recent years and are used to treat vulvodynia and scrotal pain, combined with perineal pain in women and men respectively.
We report a case of severe chronic vulvodynia and perineal pain with severe allodynia of a year’s duration, in a patient with a history of trigeminal neuralgia under pharmaceutical treatment, which was significantly resolved with a single session of bilateral neuromodulation with neurostimulation and appropriate solution injection of the vulvar nerves.
In another case, we used a bilateral pudental block to perform a perianal operation in a patient who, due to severe pathology, was unable to receive either general or spinal/epidural anesthesia, and which was successfully completed with the application of pudental blocks.
Similarly, these blocks can be used in cases where the epidural or spinal are contraindicated for analgesia in normal labor (In contrast to the old transvaginal technique that had serious possible complications)
The only alternative reliable guidance for performing a pudental block is computed tomography which, apart from the significant radiation the patient receives, is not readily available and applicable. Plain fluoroscopy doesn’t identify the vessels and nerves of the area nor the exact interligamentous plane at which the injection should be made and exposes the patient to the risk of injury to these susceptible structures.
Blocks or neuromodulation of inferior cluneal nerves are feasible only under ultrasound guidance.
Neuromodulation techniques are applied under Ultrasound guidance and are easily repeated in the safe and pleasant environment of our center.
