Résumé
Les blocs anesthésiques pudendaux ont une valeur essentielle dans le cadre du diagnostic des névralgies pudendales d’origine compressive. Dans un contexte clinique évocateur, un bloc diagnostique positif est indispensable pour conforter le diagnostic alors qu’un bloc négatif exclut ce diagnostic s’il est réalisé de façon correcte. Cet article aborde les conditions d’interprétation du test, les critères de positivité, de négativité, les différentes techniques utilisées. Nous privilégions les infiltrations guidées par l’imagerie (scanner), avec injection de produit de contraste pour apprécier la diffusion du produit; elles sont réalisées dans un premier temps au niveau de l’épine sciatique (ligament sacroépineux) puis dans un second temps au niveau du canal d’Alcock (dédoublement de l’aponévrose du muscle obturateur interne). Le bloc diagnostique a également un rôle thérapeutique, car il valide l’origine de la douleur et participe à l’alliance thérapeutique. Il permet également les injections de corticostéroïdes à visée thérapeutiques, mais celles-ci n’ont jamais été évaluées.
Abstract
Pudendal blocks are essential in the diagnosis of pudendal neuralgia resulting from nerve compression. When there is clinical suspicion of the disorder, a positive diagnostic block is crucial in confirming the diagnosis, while a negative result, when the technique is performed correctly, will exclude the diagnosis. This article addresses how to interpret test results, the criteria for positive and negative results, and the various techniques used. We suggest image-guided (scanner) infiltration, with the injection of a contrast agent to follow the diffusion of the anaesthetic. First, an infiltration is performed into the ischial spine (sacrospinatus ligament), then into Alcock’s canal (splitting of the aponeurosis of the obturator internus muscle). The diagnostic block also plays a therapeutic role because it confirms the origin of the pain and contributes to the therapeutic alliance. It also opens the way for the therapeutic injection of corticosteroids, although their effectiveness has not been investigated.
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Riant, T., Labat, J.J., Roger, R. et al. Blocs anesthésiques pudendaux dans le cadre de la névralgie pudendale par entrapment: indications, techniques, interprétation. Pelv Perineol 2, 78–85 (2007). https://doi.org/10.1007/s11608-007-0112-6
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DOI: https://doi.org/10.1007/s11608-007-0112-6