Successful Pudendal Nerve Block, now what?

[jon]

Hi All,

I had a nerve block performed at my left ischial spine and my pain was GONE for about 2 hours. It was glorious! I even had my wife stop at McDonalds, just so I could go in and sit on a hard plastic chair to see how it felt.

Since my biggest trigger point was in the left perineal area, I had Dr. Dellon cut the perineal branch of my left pudendal nerve. It helped the trigger point pain. My primary pain feels like it is my left testicle, even though removing it also did not help. Nor did cutting the genitofemoral nerve.

Are there any other nerves near the ischial spine that may have been affected by the blocking agent such that I thought the relief was from the pudendal nerve when it was really something else?

[helenlegs 11]

Isn't it a conundrum!! What does Dr Dellon say? I suppose he thought that procedure should have worked, sorry it didn't as it seems extreme
The only thing I can throw in the mix is the postfemoral cutaneous nerve PCFN perineal branch see below.
http://upload.wikimedia.org/wikipedia/c ... ray832.png
I know that I get pain here in almost exactly the line shown which is at the top back of thigh (although strangely not the part closes to bum??) and I know that I have PCFN nerve problems as it effects the back of my thigh big time. I had always put this down as sciatica but the whole of the back of my thigh is numb with the feeling of a ' long stone' inside it. The stone grows the more 'activity' until it feels like a vice like grip in back of thigh. Anything similar? you do mention sciatica. Get the feet thing too btw.(numb soles, burning and shooting 'pins and needles')
What about obturator interus nerve? http://www.dartmouth.edu/~humananatomy/ ... 4/14-2.HTM it follows a similar path to pudendal from this pic.
take care,
Helen

[Violet M]

I've heard of the medication getting over to the sciatic nerve and causing an inability to walk for a short period after the pudendal nerve block but that's the only other nerve I've heard of being affected.

Violet

[jon]

I had one previous pudendal block way back when my PT thought the problem was my pelvic floor. I had that exact response, in that I could not walk. The whole focus was to have a friend drive me 35 miles to my PT ASAP to see if my pelvic floor felt any better after the block. I didn't even pay attention as whether or not it helped my groin pain - oddly enough!

When I got my second pudendal block, I initially wanted him to block the femoral cutaneous nerve, so that I'd be sure it wasn't that nerve before I had the perineal branch of the pudendal nerve cut. He talked me into blocking the pudendal nerve instead and my pain was GONE!!! Knowing that, I was really excited to have the perineal branch cut. Really bummed it wasn't "The Cure".

Regarding the femoral cutaneous nerve. Could the nerve block at the ischial spine location have affected that nerve? If that nerve is the problem, what can you do about it?

I've had botox in the obterator and piriformis muscle and that didn't help. I am trying to remember something I read a while back (really bad cognition now - Gabepentin related). I read something like 15% of people have one of these nerves that splits off and goes to the piriformis muscle. I know nothing about a piriformis nerve.

http://www.diagnosispro.com is a great tool where you can enter both (in my case) testicle pain and sciatica and it will list all the conditions that can cause both. I came up with Piriformis Syndrome and Ischial Tunnel Syndrome. I am waiting to see abour having EMG testing (FAIR Test).

The sciatica is new so my insurance will pay for it. They are trying to say groin pain is pre-existing. Grrr.

Happily, I got a call today that my SSDI has been approved! Unfortunately, or fortunately, it will just be subtracted from the amount I get from my private disability insurance company. At least I can get Medicare next September!

[Violet M]

Jon, Dr. Dellon"s shows pictures of someone who had the PFCN decompressed so if that is your problem, I guess you could have another surgery. There are people who have had both the PFCN and the pudendal decompressed.

So, I'm not sure exactly what the entire course of the PFCN is -- whether it comes close to the pudendal near where your pudendal block was given but in the drawings you see of it, it appears more superficial. According to wiki it runs under the piriformis and glute so it seems some of the medication could have wandered into the area -- depending on how much they used.

Violet

[jo jo]

Was wonderin if anyone has had the same problem as I wil PN blocks. After about 2/3 weeks of getting the block I have
started vaginal bleeding having my period for about a week or so. Even being in menopause still getting a period. Dr
seems to think the bleeding is caused by the cortizone which can happen? Have had about 4 nerve blocks in the past
year and they have really helped. Botox has def helped with PVD.

Thanks

Jo Jo

[Violet M]

Welcome Jo Jo. I've not heard of this happening but steroid epidurals can so it makes sense I guess. http://www.neurosurgery.vcu.edu/pdfs/epidural.pdf

[jon]

I have a new pain doctor and I am going to have an injection in my piriformis muscle this morning.I also have another nerve block to my pudendal nerve scheduled for next week.

at this point I'm really thinkink that my piriformis muscle. The figure four stretch that I do everyday subconsciously turns out to be a piriformis muscle stretch. I also used my left foot in a pronated position on a knee roller/walker for 3 months prior to the pain starting because of an injury to my right side which is my non-pain side. I've read that that can cause piriformis syndrome.

My new doctor said the piriformis can't affect the pudendal nerve. From a PubMed paper I just read compression of the pudendal artery can cause my testicle pain. Taking the paper to show the doctor.

I am also looking into participating in the Accurate clinical trial being put on by the company Spinal Modulation. It is for a nerve root stimulator that is implantable. My former pain doctors is one of the investigators. My back surgeon helped design the device.

[jon]

My recent pudendal nerve block did nothing. I reviewed my early records, when I had not educated myself, and I also had a pudendal block before my left orchiectomy that didn't help.

I'm more convinced than ever that the 2cc of numbing agent seeped into something else in that area. The million dollar question is - WHAT!!!???

[Violet M]

Jon, was the pudendal nerve distribution area numbed right after the block? If not, then the medication may not have gotten to the pudendal nerve. If the area was numbed but you had no pain relief -- even for a couple of hours, then you would want to consider other possibilities. Was the pudendal nerve block done at the ischial spine or the alcock's canal?

Violet