Archives of Gynecology and Obstetrics

, Volume 293, Issue 4, pp 805–813 | Cite as

New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

  • Stefan Weinschenk
  • Markus W. Hollmann
  • Thomas Strowitzki
General Gynecology

Abstract

Purpose

Pudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique.

Patients and methods

We analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA), procaine in 20 patients. A 0.4 × 40 mm needle was handled using a stop-and-go technique while monitoring the patient’s discomfort. The needle was placed 1–2 cm laterally to the dorsal introitus. After aspiration, a small amount of LA was applied. After subcutaneous anesthesia, the needle was further advanced step-by-step. Thus, 5 ml could be applied with little discomfort to the patient. Anesthesia in the pudendal target region was the primary endpoint of our analysis.

Results

In 93 of 105 injections (88.6 %), complete perineal anesthesia was achieved with a single injection. 12 injections were repeated. These injections were excluded from the analysis. Severity of injection pain, on visual analog scale (VAS) from 0 to 100, was 26.8 (95 % CI 7.2–46.4). Age (β = 0.33, p < 0.01) and the number of previous injections (β = 0.35, p < 0.01) inversely correlated with injection pain. Injection pain and anesthesia were not affected by BMI, the number and the side of previous injections, or order of injection. A reversible vasovagal reaction was common, but no serious adverse effects occurred.

Conclusion

Perineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.

Keywords

Nerve block Perineal region Therapeutic local anesthesia Neural therapy Procaine Vulvodynia 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Stefan Weinschenk
    • 1
    • 2
    • 3
  • Markus W. Hollmann
    • 3
    • 4
  • Thomas Strowitzki
    • 2
    • 3
  1. 1.Gemeinschaftspraxis für Frauenheilkunde und Naturheilverfahren – Dr. med. Stefan Weinschenk, Dr. med. Annerose SchererKarlsruheGermany
  2. 2.Department of Gynecological Endocrinology and Fertility DisordersWomen’s Hospital University of HeidelbergHeidelbergGermany
  3. 3.The Heidelberg University Neural Therapy Education and Research Group (HUNTER Group)
  4. 4.Department of AnesthesiologyAMC University of AmsterdamAmsterdamThe Netherlands

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