I think my blocks failed :(

[sailor_moon]

Hi,

I had 2 nerve blocks done with Hyaluronic acid 2 days ago and I think they failed. It got injected into my back/buttock area, and when this got done I did not feel any anesthetic travel to my vulva at all!nor did I feel numb in my genital area. I then got injected with Hyaluronic acid and I didn't feel that either.

I have had 2 prior nerve blocks done injected into my inner thigh, crotch area and I could feel it travel into my vulva and give me total numbness and relief.

I just forked out $1000 for this procedure and I believe it has failed in comparison to the other ones I have had in the past. I got this one done by a pudental specialist, the other was just done by my gynecologist and it actually numbed me out. It really upsets me to think I have thrown away $1000 on something that has failed.

Given that I did not feel numbness in my genitals, does this mean it failed?

[Violet M]

I think it could mean that the medication didn't reach the targeted area of the pudendal nerve. Since the nerve innervates the vulva area, there should be a temporary loss of sensation in that area after the block. This can be tested with the pinprick test. If the genital area becomes numb but you still have pain it can mean the proper nerve was numbed but that the pain is caused by something other than that nerve.

The fact that you didn't experience any numbness in the genital area could be due to a variation in typical anatomy or due to thick ligaments that made it difficult to access the nerve via the buttocks. Do you know what type of imaging was used? If the block was done using fluoroscopy at the level of the ischial spine they typically target the the nerve by using the the bony landmark of the ischial spine -- they can't actually see the nerve. So there is some room for error as far as actually reaching the nerve. Some people (I was one of them) have thick or hardened and sclerosed ligaments that make it difficult to get the needle to the nerve when you go in through the buttocks.

However, your specialist should have discussed all of this with you and explained everything to you. If they didn't, I think they owe it to you to do so. Maybe they have a better explanation than what I have just given you. If they won't explain it, maybe you could refuse to pay the bill and write them a letter stating why. I know you are struggling financially and I can understand why you would be so upset.

Violet

[sailor_moon]

There was no imaging used because unfortunately I couldn't afford the $3500 to have it done that way but seeing as the professor has seen over 12,000 patientsand done blocks they said there would only be a 10% accuracy difference.

I had no imaging used in previous blocks by the gyno who went through my groin but I felt the anesthetic travel into the affected areas in my vulva and got relief the 3 times it got done.

They did anesthetic first and the hyaluronic acid afterwards. I dont know how long it takes for the acid to work properly in helping heal the nerve...I hope it got to the right area but I didnt feel it. However, when he injected my left side,the area he injected into really hurt so he said he must be in the right spot.

Can I ask if you had nerve blocks injected any other way that did have a positive effect? Like I did through my groin.

They want me to fork out another $1000 in month for another 2 blocks....but now I am unsure seeing as I havnt had the ideal result

[Violet M]

Sailor Moon,

Pudendal nerve blocks can be given through the buttocks without imaging but it's not an ideal way to have it done. I've heard the way that Dr. Weiss does it is to find the area that is painful with his finger inserted in the vagina or anal area and then aim through the buttocks for that painful spot to inject the medication. Is that how yours were done?

I've had a PN block done without imaging via the vagina but never through the groin. It helped some but none of my blocks, including the ones done with imaging relived my symptoms 100%.

I completely agree with you that it doesn't make a lot of sense to fork out more money for something that didn't help.

Violet

[sailor_moon]

On a positive note, I went through with the 2nd round of nerve blocks and he definitely got the right spot! I could feel it going to my genital area and got 2 weeks of relief! Big difference in effectiveness the 2nd time around!

[JennaM]

Hi ladies, I also had 2 injections with Hylarounic acid and both times no numbness at all, but after 1st block about 2 weeks I had a complete relief that lasted for about 2-3 weeks, after the 2nd block nothing..
He did with fluoroscopy guidance and was sure he got it in the right spot, but now I have my doubts because I didnt go numb both times.. My doc says it's possible because it was only unilateral and he injected more of acid than anesthetic, but PT says I should have gone even slightly numb.. I am not sure whats happening! but pain is typical for PN: left buttock, outer left genital area and burning. Cant go up the stairs and not end up in pain afterwards.

[Violet M]

I'm not too familiar with hyaluronic acid injections. Does the hyaluronic acid cause numbness or are the injections usually combined with a numbing anesthetic like marcaine?

Violet