Successful Pudendal Nerve Block, now what?

Nerve blocks using many techniques, and medications - options discussed in detail

Re: Successful Pudendal Nerve Block, now what?

Postby Violet M » Tue Apr 15, 2014 9:47 pm

jon wrote:Excellent question. It was at the Ischial Spine.

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


Ischial spine and Alcock's canal are the 2 most common sites of entrapment that are mentioned in the literature so many PN docs try blocks at both places to see if one or the other helps. My understanding is that Dr. Hibner's team does both sites at once by injecting a large volume of medication so it gets to both areas since they aren't too far apart.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: Successful Pudendal Nerve Block, now what?

Postby jon » Wed May 14, 2014 4:30 am

Violet - I have had 3 pudendal nerve blocks. Only the 2nd one took pain AWAY!The first and second were at the ischial spine spine, for sure. The third one was only 9 months ago. I will find out, but I think it was there also.

When the first one didn't help, my left testicle was cut off. I don't remember the doctor saying anything about the pudendal nerve and I had to recently go back to my pre-orchiectomy records recently to find out that I even had one. I came up with researching the pudendal nerve on my own.

Can you please send via PM or post, any information for other methods of nerve blocks besides at the ischial spine? I just got off the phone with my pain doctor and asked him about it. He said it's easy for women and he said something about doing it via the perineal area on men.

I'm in a clinical trial for a Dorsal Root Ganglion nerve stimulator, the Axium. The doctor also agreed to put a lead in the S2 area where it enters the plexus. Of the 4 leads, that is the only one that is still providing any therapy I can feel. And if it helps at all, it's not much. My pain doc wants to explant the device. I'm about at that point myself. My 9th surgery in 5 years. Great.

He agreed to try the other blocks but wants to take out the device first.

If the block at the ischial spine worked (which lead me to have Dellon cut the perineal branch), what can be learned by doing the other blocks?
Left testicle pain since 2008. Left sciatic-area since 2012. Failed left epididectomy, orchiectomy, botox injections, nerve blocks and internal physical therapy. Genital branch of genitofemoral and perineal branch of pudendal nerve cut. Failed microdiscectomy for bulge at L5-S1. I still have left sciatica/foot numbness and left testicle-area pain. Dorsal Root Ganglion nerve stimulator failed to help and was removed. I have had 4 pudendal nerve blocks, 2 from Dr. Poree worked for 2 hrs.
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Re: Successful Pudendal Nerve Block, now what?

Postby flyer28 » Thu May 15, 2014 12:19 pm

I think that basically the block at ischial spine should numb all the route of the nerve, because all other spots of possible entrapment are distal from ischial spine. So the succesful block at ischial spine confirmes that the source of the pain is the pudendal nerve. Alcock canal block and dorsal nerve block are two other possible places. But in reality it is sometimes not that simple. I have heard that Alcock block is least risky option, my urologist is doing Alcock block also unguided, for CPPS or chronic prostatitis, without any complication. Dorsal nerve block is difficult to find right spot, best device for that is high resolution ultrasound.
summer 2009 - episodic pain in genital area, mainly after sex, then also after any other physical labour
early 2010- major flare-up, lasting 3 months, later almost complete resulion of pain
late 2010 - chronification of pain
february 2011 - ESCW wave. major flare-up of debilitating pain, lasting 5 months
february 2012 - diagnosed CPPS with irritation of pudendal nerve, hypogastric plexus block
june 2012 - dorsal nerve block made by prof. Aszmann, no relief
november 2012 - worsening of pain
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Re: Successful Pudendal Nerve Block, now what?

Postby Violet M » Sat May 24, 2014 10:18 pm

Jon, this article describes PN blocks at the ischial spine at at the pudendal canal. (Alcock's canal). http://www.pudendalhope.info/sites/defa ... eBlock.pdf
I don't remember any articles that describe dorsal nerve blocks. But as flyer said, the blocks at the ischial spine target the main trunk of the nerve and typically the PN branches out after that, although on some people there are variations in the anatomy in which the rectal branch comes off differently.

There are different types of guidance such as ultrasound, CT, fluoroscopy, nerve stimulation, or just finger guidance -- depending on the physician's preference but it's where the block is targeted that makes the difference. I'm not sure what you would learn by having more blocks, really, and I'm not sure what other types of blocks your pain doc was thinking of but if your pain is primarily scrotal/perineal it seems unlikely that a dorsal penile nerve block would help. Some of the other blocks that people have tried are ganglion impar blocks, genitorfemoral nerve blocks, and inguinal nerve blocks but I don't know exactly where your pain is so I don't know if any of these would make sense for you. I hope you can get this sorted out and find something that helps.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: Successful Pudendal Nerve Block, now what?

Postby jon » Thu Dec 10, 2015 6:01 am

I just repeated the block with the same doctor who gave me the block that worked. Apparently my memory of him having a speaker on his probe was from a different procedure he did, maybe botox where it was the muscle that was making the sounds. To ensure he is in the right spot, he runs electrical current into the area until it stimulated the pudendal nerve. Never agree to have a doctor only use visualization or feel to block your PN. I made that mistake twice. The first one cost me a testicle unnecessarily.

The recent block helped my pain again, but my question remains - now what? Since 1/3 of those who have surgery to trace the length of the nerve and look for impingements have no improvement, 1/3 improve and 1/3 get worse. I don't like those odds, especially after 9 surgeries in 6 years, not including surgery for the cancer that was found while looking for the source of the pain.

The nerve stimulator I tried failed. I do know one PN patient whose life was changed by an implantable morphine pump that deliverers the drug right where it's needed.

Anyone else tried anything that worked?
Left testicle pain since 2008. Left sciatic-area since 2012. Failed left epididectomy, orchiectomy, botox injections, nerve blocks and internal physical therapy. Genital branch of genitofemoral and perineal branch of pudendal nerve cut. Failed microdiscectomy for bulge at L5-S1. I still have left sciatica/foot numbness and left testicle-area pain. Dorsal Root Ganglion nerve stimulator failed to help and was removed. I have had 4 pudendal nerve blocks, 2 from Dr. Poree worked for 2 hrs.
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Re: Successful Pudendal Nerve Block, now what?

Postby Violet M » Sun Dec 20, 2015 4:32 am

Hi Jon,

I know it's a tough decision on what treatments to pursue. Dr. Redmond is a big proponent of using electrical stimulation for nerve blocks. Do you know of other physicians who use that method? Just thinking of it logically, it seems like it would be one of the most accurate methods for delivering the medication to the right spot.

Where did you get the statistic that 1/3 of patients get worse from surgery? I have never heard of that before.

On this forum, there have been mixed reviews on pain pumps for people with PN. Some people have found them helpful while others have not. Unfortunately, it's like most other treatments for this illness; you don't know until you try it whether it will work for you.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Postmenopausal bleeding after pn nerve block

Postby Cintapoppy » Tue Mar 15, 2016 1:08 pm

jo jo wrote:Was wonderin if anyone has had the same problem as I wil PN blocks. After about 2/3 weeks of getting the block I have
started vaginal bleeding having my period for about a week or so. Even being in menopause still getting a period. Dr
seems to think the bleeding is caused by the cortizone which can happen? Have had about 4 nerve blocks in the past
year and they have really helped. Botox has def helped with PVD.

Thanks

Jo Jo

Hi, just wanted to say that I too started bleeding 2 weeks after a pn nerve block despite being 9 years post menopausal and have never had a bleed since i stopped. Had a hysteroscopy and all clear. After the injection i started to feel like i had pmt although the penny didn't drop till i researched bleeding and nerve blocks. It usually comes up as epidural injections, like Violet suggested. I am not sure that i want another pn nerve block because it made me feel very unwell plus the pmt and bleeding symptoms. Maybe steroid injections don't agree with everyone?? Your input of your side effects would be much appreciated.
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Re: Successful Pudendal Nerve Block, now what?

Postby jon » Tue Oct 10, 2017 11:21 pm

Long ago thread, sorry. Got discouraged.

It was at the ischial spine. I had it done again by the same doc, but the anesthesia had me so high, I couldn't tell for sure if it worked. That really surprised me!

I asked him if he knew another approach for the block, but he didn't and insisted that was how he was doing it.
Left testicle pain since 2008. Left sciatic-area since 2012. Failed left epididectomy, orchiectomy, botox injections, nerve blocks and internal physical therapy. Genital branch of genitofemoral and perineal branch of pudendal nerve cut. Failed microdiscectomy for bulge at L5-S1. I still have left sciatica/foot numbness and left testicle-area pain. Dorsal Root Ganglion nerve stimulator failed to help and was removed. I have had 4 pudendal nerve blocks, 2 from Dr. Poree worked for 2 hrs.
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