Date: 16 Nov 2012
Pudendal nerve block in HDR-brachytherapy patients: do we really need general or regional anesthesia?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
In male patients, the pudendal block was applied only in rare cases as a therapy of neuralgia of the pudendal nerve. We compared pudendal nerve block (NPB) and combined spinal-epidural anesthesia (CSE) in order to perform a pain-free high-dose-rate (HDR) brachytherapy in a former pilot study in 2010. Regarding this background, in the present study, we only performed the bilateral perineal infiltration of the pudendal nerve.
In 25 patients (71.8 ± 4.18 years) suffering from a high-risk prostate carcinoma, we performed the HDR-brachytherapy with the NPB. The perioperative compatibility, the subjective feeling (German school marks principle 1–6), subjective pain (VAS 1–10) and the early postoperative course (mobility, complications) were examined.
All patients preferred the NPB. There was no change of anesthesia form necessary. The expense time of NPB was 10.68 ± 2.34 min. The hollow needles (mean 24, range 13–27) for the HDR-brachytherapy remained on average 79.92 ± 12.41 min. During and postoperative, pain feeling was between 1.4 ± 1.08 and 1.08 ± 1.00. A transurethral 22 French Foley catheter was left in place for 6 h. All patients felt the bladder catheter as annoying, but they considered postoperative mobility as more important as complete lack of pain. The subjective feeling was described as 2.28 ± 0.74. Any side effects or complications did not appear.
Bilateral NPB is a safe and effective analgesic option in HDR-brachytherapy and can replace CSE. It offers the advantage of almost no impaired mobility of the patient and can be performed by the urologist himself. Using transrectal ultrasound guidance, the method can be learned quickly.
Schenck M, Krause K, Schwandtner R, Haase I, Fluehs D, Friedrich J, Jaeger T, Boergermann C, Ruebben H, Stuschke M (2006) High-dose rate brachytherapy for high-risk prostate cancer. Urologe A 45(6):715–716, 718–722. doi:10.1007/s00120-006-1083-x
Labat JJ, Robert R, Bensignor M, Buzelin JM (1990) Neuralgia of the pudendal nerve. Anatomo-clinical considerations and therapeutical approach. J Urol (Paris) 96(5):239–244
Amarenco G, Savatovsky I, Budet C, Perrigot M (1989) Perineal neuralgia and Alcock’s canal syndrome. Ann Urol (Paris) 23(6):488–492
Peng PW, Tumber PS (2008) Ultrasound-guided interventional procedures for patients with chronic pelvic pain—a description of techniques and review of literature. Pain Physician 11(2):215–224PubMed
Gerheuser F, Roth A (2007) Epidural anesthesia. Anaesthesist 56(5):499–523; quiz 524–496. doi:10.1007/s00101-007-1181-1
- Pudendal nerve block in HDR-brachytherapy patients: do we really need general or regional anesthesia?
World Journal of Urology
Volume 31, Issue 2 , pp 417-421
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Pudendal nerve block
- Epidural anesthesia
- Transrectal ultrasound
- Industry Sectors
- Author Affiliations
- 1. Department of Urology and Urooncology, University of Essen Medical School, Hufelandstraße 55, 45122, Essen, Germany
- 4. Practice Clinic Anesthesiology, Essen, Germany
- 3. Department of Radiooncology, University of Essen Medical School, Essen, Germany
- 2. PURR, Practice Clinic Urology Rhein-Ruhr, Mülheim, Germany