Measuring quality of pudendal nerve blocks

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Measuring quality of pudendal nerve blocks

Postby Violet M » Sat Aug 20, 2016 10:23 pm

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: Measuring quality of pudendal nerve blocks

Postby Violet M » Sat Aug 20, 2016 10:37 pm

Compare the previous article to this one:

http://www.ncbi.nlm.nih.gov/pubmed/26999519

Not sure what to make of it all. Should you try a nerve block for diagnostic purposes or not?

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: Measuring quality of pudendal nerve blocks

Postby RJR » Sun Aug 21, 2016 2:27 pm

Thanks, Violet, for posting the studies. It is good to see interest of the medical community in PNE.

I can only offer my experience. To date I've had ~ 10 Pudendal nerve blocks: 4 CT-guided to the notch (pre-and post surgery), 2 perineal ultrasound guided (post surgery), and 4 MRI guided (post surgery).

Only the MRI guided provided long term relief, with Kenalon being better than Celestone as the steroid. My sense is that accuracy of the delivery is a key "quality" factor, with MRI guidance being the most accurate when used by skilled hands. In my case I had some post op scarring that partially re-entrapped the nerve (much less so than pre-op). MRI guidance allowed the injection of the steroid into the void between the nerve and surrounding scar tissue, thereby retaining steroid contact with the nerve. The MD noted by MRI (post injection) that the scar tissue puffed like a balloon with the steroid fluid. I experience several months of relief.

Pre-op, I was severely entrapped by the R STL...and the 3 pre-op steroid injections (no surprise) did not provide sustained relief. And I doubt the MRI injections would have done any better pre-op - again because the entrapment was so severe.

So, I believe key quality factors are method of guidance, type of steroid (long lasting), and severity and type of entrapment.

Bob
Cyclist till perineal pain onset R side (Apr'08). Dx with PN (Aug'09). Lyrica gave 30% pain reduction. Potter MRI (Oct'10) validated at surgery with Dr Hibner (Nov'10) - found nerve attached to scarred STL. Now sitting 10 hrs/day vs 1 hr/day pre-op. Occasional MRI-guided steroid injections by Dr. Jan Fritz at Johns Hopkins. Surgery video = http://www.youtube.com/watch?v=6FDwana6SQU

Deep neuropathic burning pain flares have been gone since surgery...Grateful to Dr Hibner.
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Re: Measuring quality of pudendal nerve blocks

Postby Violet M » Sun Sep 04, 2016 3:34 am

Makes a lot of sense, Bob -- that steroid injections won't help if the ligaments are entrapping the nerve but might be able to get rid of some of the post-op scar tissue.

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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Violet M
 
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