World Journal of Urology

, Volume 31, Issue 2, pp 417–421 | Cite as

Pudendal nerve block in HDR-brachytherapy patients: do we really need general or regional anesthesia?

  • Marcus Schenck
  • Catarina Schenck
  • Herbert Rübben
  • Martin Stuschke
  • Tim Schneider
  • Andreas Eisenhardt
  • Roberto Rossi
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Pudendal nerve block Epidural anesthesia Infiltration Transrectal ultrasound HDR-brachytherapy 

References

  1. 1.
    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 Google Scholar
  2. 2.
    Schenck M, Kliner SJ, Achilles M, Schenck C, Berkovic K, Ruebben H, Stuschke M (2010) Pudendal block or combined spinal-epidural anaesthesia in high-dose-rate brachytherapy for prostate carcinoma? Aktuelle Urol 41(1):43–51. doi:10.1055/s-0029-1224722 PubMedCrossRefGoogle Scholar
  3. 3.
    Scudamore JH, Yates MJ (1966) Pudendal block—a misnomer? Lancet 1(7427):23–24PubMedCrossRefGoogle Scholar
  4. 4.
    Niesel HC, Eilingsfeld T (1994) The extent of spinal anesthesia depends on the amount of he injected local anesthetic–fact or fiction? Anasthesiol Intensivmed Notfallmed Schmerzther 29(7):427–429PubMedCrossRefGoogle Scholar
  5. 5.
    Ohel G, Gonen R, Vaida S, Barak S, Gaitini L (2006) Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol 194(3):600–605. doi:10.1016/j.ajog.2005.10.821 PubMedCrossRefGoogle Scholar
  6. 6.
    Hagen NA (1993) Sharp, shooting neuropathic pain in the rectum or genitals: pudendal neuralgia. J Pain Symptom Manage 8(7):496–501PubMedCrossRefGoogle Scholar
  7. 7.
    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):239–244Google Scholar
  8. 8.
    Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, Leborgne J (1998) Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20(2):93–98PubMedCrossRefGoogle Scholar
  9. 9.
    Birch BR, Gelister JS, Parker CJ, Chave H, Miller RA (1991) Transurethral resection of prostate under sedation and local anesthesia (sedoanalgesia). Experience in 100 patients. Urology 38(2):113–118PubMedCrossRefGoogle Scholar
  10. 10.
    Birch BR, Miller RA (1991) Birch-Miller electrotest needle: aid to local anesthetic endoscopic surgery. Urology 38(1):64–65PubMedCrossRefGoogle Scholar
  11. 11.
    Chander J, Gupta U, Mehra R, Ramteke VK (2000) Safety and efficacy of transurethral resection of the prostate under sedoanalgesia. BJU Int 86(3):220–222PubMedCrossRefGoogle Scholar
  12. 12.
    Akalin Z, Mungan NA, Basar H, Aydoganli L, Cengiz T (1998) Transurethral resection of the prostate and laser prostatectomy under local anesthesia. Eur Urol 33(2):202–205PubMedCrossRefGoogle Scholar
  13. 13.
    Rodrigues AO, Machado MT, Wroclawski ER (2002) Prostate innervation and local anesthesia in prostate procedures. Rev Hosp Clin Fac Med Sao Paulo 57(6):287–292PubMedCrossRefGoogle Scholar
  14. 14.
    Amarenco G, Savatovsky I, Budet C, Perrigot M (1989) Perineal neuralgia and Alcock’s canal syndrome. Ann Urol (Paris) 23(6):488–492Google Scholar
  15. 15.
    Robert R, Labat JJ, Bensignor M, Glemain P, Deschamps C, Raoul S, Hamel O (2005) Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 47(3):403–408. doi:10.1016/j.eururo.2004.09.003 PubMedCrossRefGoogle Scholar
  16. 16.
    Mauillon J, Thoumas D, Leroi AM, Freger P, Michot F, Denis P (1999) Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia. Dis Colon Rectum 42(2):186–192PubMedCrossRefGoogle Scholar
  17. 17.
    Shafik A, el-Sherif M, Youssef A, Olfat ES (1995) Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 8(2):110–115. doi:10.1002/ca.980080205 PubMedCrossRefGoogle Scholar
  18. 18.
    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):215–224PubMedGoogle Scholar
  19. 19.
    Thoumas D, Leroi AM, Mauillon J, Muller JM, Benozio M, Denis P, Freger P (1999) Pudendal neuralgia: CT-guided pudendal nerve block technique. Abdom Imaging 24(3):309–312PubMedCrossRefGoogle Scholar
  20. 20.
    Gruber H, Kovacs P, Piegger J, Brenner E (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: topographic basics. Dis Colon Rectum 44(9):1376–1380PubMedCrossRefGoogle Scholar
  21. 21.
    Kovacs P, Gruber H, Piegger J, Bodner G (2001) New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 44(9):1381–1385PubMedCrossRefGoogle Scholar
  22. 22.
    Gerheuser F, Roth A (2007) Epidural anesthesia. Anaesthesist 56(5):499–523; quiz 524–496. doi:10.1007/s00101-007-1181-1 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Marcus Schenck
    • 1
  • Catarina Schenck
    • 4
  • Herbert Rübben
    • 1
  • Martin Stuschke
    • 3
  • Tim Schneider
    • 2
  • Andreas Eisenhardt
    • 2
  • Roberto Rossi
    • 1
  1. 1.Department of Urology and UrooncologyUniversity of Essen Medical SchoolEssenGermany
  2. 2.PURR, Practice Clinic Urology Rhein-RuhrMülheimGermany
  3. 3.Department of RadiooncologyUniversity of Essen Medical SchoolEssenGermany
  4. 4.Practice Clinic AnesthesiologyEssenGermany

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