Successful Pudendal Nerve Block, now what?

[flyer28]

Violet what do you think which place has the injection higher chance to catch pudendal nerve more exactly, Alcock or sacrotub/sacrospin ligament?
My urologist is doing solely Alcock blocks, stating that this is the best place to anesthetize pudendal nerve.
Unfortuneately he is doing this unguided, stating that he never had any complications.
However, I am still afraid, that I will be his first victim....
I had unguided hypogastric plexus block with him, mild improvement of pain, but nothing breakthrough. Fortunately, no worsening.
I am longer heading for Alcock bloc, my problem site is more distal (probably dorsal canal) but I got the feeling that if you catch the pudenadal nerve in Alcock, everything more distal shoould be numbed, right?
I had failed dorsal nerve block, made with ultrasound assistence (dr.Bodner), the injection was super-exact, with high resolution ultrasound (even I was able to see partially the nerve), but no effect - neither numbing, nor worsening.
Maybe my pathology is higher or maybe it is not sole pudendal nerve.
Would you prefer Alcock location over the sac ligamnet location?
Flyer28

[Violet M]

Flyer, I'm not sure you can say either place is best. Alcock's is more distal than the ischial spine and the block should cause loss in sensation in whatever is distal to Alcock's. If the PN distribution area is numbed and your pain is temporarily relieved that suggests there is pudendal neuralgia. A block at the ischial spine is more proximal and would therefore affect the part of the nerve distal to the ischial spine. I guess you could say the ischial spine block covers a longer portion of the nerve. The inferior rectal nerve may branch off before Alcock's so if you have rectal pain it might be less likely to be covered by an Alcock's block, although it can depend on the anatomy since there are variations in anatomy from person to person.

Good luck with your block. I hope all goes well for you and will be interested to hear if it helps you.

Best,

Violet

[flyer28]

Thank you Violet. I will certainly opt for Alcock, there is fewer risks than at ischail spine, and my symptoms are frontal, no rectal pain, no sitting pain. If there is any pudendal neuropathy it is surelly distal from Alcock.

[Melanie9999]

Hi everyone, a lot later on and still not got very far. I had the pudendal block, which did get rid of the pain for about 3 hours, but then the pain worsened to more than before, however it is early days, it has only been a week and so far still much worse than before. Is this normal? I would have thought that was a positive block, right nerve has been located and therefore just need to work out treatment for that nerve. If it was wrong nerve then I would not have had pain releif while the anaesthetic was in I suppose. It must have spread slightly though as I was paralyzed on the right leg, had bilateral blocks as I have pain on both sides. I think it is coming from my pelvic floor, I am convinced of it! I haven't been allowed to try Diazepam etc because I have depression, which I have had ever since I got sick many years ago. I handle it well on the surface, but underneath I am very unhappy, I can't really cope with it but I tend to have a stiff upper lip approach I don't do that intentionally, I just can't cry in front of people!

I have been diagnosed with anismus from a proctogram, basically my pelvic floor does not relax. I have bladder pain, constipation, pirifirmis and buttock pain and PGAD, the PGAD is the worst of the symptoms. I was referred to Mr Anthony Dixon because of the anismus, on the 7th October. Seeing Mr Dixon on Thursday, hoping to have botox. Has anyone else had all of these symtpoms and had botox? I had a pudendal block a week ago, so far it has made it worse but it is early days. I couldn't walk either, it made my thighs and buttocks so weak I couldn't stand up or walk all day I was paralyzed! I can walk now, but I am a weaker, however I have had muscular problems for a long time, and the endometriosis was so bad that I used to really tense up.

Any ides if botox is a possiblity and if it is dangerous etc? I really want to try something to relax my pelvic floor, I think my pelvic floor is causing this pain as the pain is level with my bladder in the vaginal area and in the bladder and in the rectum and severe pain on sitting on the buttocks even on a toilet seat, valley cushion helps a bit becuase it is soft. xxx

[jon]

Sorry for the slow response to your important question.

I know for sure the one that took the pain away was at the ischial spine. I was told that was the only place it is ever done so I had assumed the other 2 were there also. For the one that worked my pain doc used a needle probe attached to a speaker so he was certain he got the nerve with the medication.

What does that indicate to you?

[Melanie9999]

If your pain went away while the anaesthetic was working (2 or 3 hours) then they had got the right nerve, and it means that it is coming from that nerve, that is what I understand it to mean. Hope that helps x

[Violet M]

Melanie, it's common to have a flare-up for a month or so after a nerve block, even if you initially had several hours of relief. Hope you feel better soon. Icing or increased pain medication might help.

Jon, pudendal nerve blocks can be given at the ischial spine, alcock's, or the dorsal nerve area. If you had temporary relief along with temporary loss of sensation or numbess in the distribution area of the pudendal nerve that is an indication of a possible pudendal neuralgia diagnosis.

Violet

[jon]

Excellent question. It was at the Ischial Spine.

What are the advantages of trying a block at the Alcock Canal?

The doc who did the second block used a needle probe with a speaker attached to be sure the block was in the right place (along with fluoroscopy). When he touched the nerve with the probe you could actually HEAR how active the nerve was. He said that is not normal.

[jon]

Hi Violet,

I just noticed you said a third option was a "dorsal" block. Where exactly would that be done?

Dr. Dellon cut the perineal branch of my pudendal nerve. It helped a major trigger point, but not my primary pain.

I do not have anal pain - Thank you God!

[flyer28]

Jon, I had dorsal nerve block done by prof. Bodner in Vienna, 1 and half year ago.
No improvement and I did not have any Tinnel sign, so this contributed to my decision not to go for opeartion.
I felt the needle piercing something, than sharp short pain, but no effect, neither flare-up nor improvement.
Dorsal nerve block (on the right side) is administrated somewhere near medium side of groin, I could not see it precisely. It was done by ultrasound which is the best tool, you can see the nerve in high frequency ultrasound and everything is in real time condition (unlike CT guided method).
I am contemplating to try Alcock, even if I know that my pathology is more distal than Alcock. One of my urologist is doing these blocks even unguided, stating that this is the most efficent place to give pudendal block.