Obstetrician for pudendal nerve block?

[calluna]

I've been talking to my GP about pudendal nerve blocks, and he's suggested something which seems incredibly logical to me. I thought I'd run it past you all here on the forum and see what people think.

It seems to be the case that there are not many pain management doctors who do pudendal nerve blocks, and even fewer who get good results. However there is one class of specialists who do pudendal nerve blocks all the time, on a regular basis - obstetricians. And they get good results, this is routine work for them. However, you don't tend to find obstetricians working in pain management.

My GP has suggested asking my gynaecologist, who is also an obstetrician, if he would do a pudendal nerve block for me. (We'd probably only be turning in this direction if I'm not happy with gabapentin long term.)

But I was just wondering - has anyone else considered seeing an obstetrician, and asking them if they would consider doing a pudendal nerve block?

[sgrandy]

Hi Calluna,

I'm not an expert on anything related to this condition and I'm sure some of the more seasoned folks will you give you an opinion but the only issue I see this is that the block would be unguided (using a finger to guide the needle and not CT, Ultrasound etc. to visualize the proper placement of the needle). I suppose it really just depends on your comfort level with having a block done this way as opposed to guided although I can see the rationale behind approaching an obstetrician to do it. I haven't had any nerve blocks, myself, so I can't say much more than that

[Celeste]

I had one of these unguided PN blocks from a urogynecologist. In the US, the "saddle block" has fallen out of favor as the epidural has become the gold standard of anesthetic nerve block. This is indeed done by locating bony landmarks manually and inserting the needle through the vagina to reach the area of the nerve.

I don't have anything good to say about my experience with it, but if it's the only avenue you have I guess that's a rationale.

[calluna]

Ah - that puts it in perspective. I knew there would be somebody! Thankyou Celeste - and sgrandy. It's not the only avenue that I have - it is just the easiest.

[nyt]

If this is the only avenue you have then that is the route you must try. Having said that if you are thinking about seeing any of the PN doctors, I think probably all of them will you require you to have the block done guided so they know the pudendal nerve was the only nerve blocked.

[johnd.h]

Would this be unguided though, surely not? I wouldn't consider it for a moment unless guided by whatever method.

Best wishes to you with whatever route you choose.

John

[sgrandy]

It most likely would be unguided through the vaginal wall. Basically, the doctor uses his finger to locate where the nerve is and then uses that finger to guide the needle...this is what an obstetrician does to anesthetize a woman's vaginal area for childbirth. I don't know how often they do those blocks as most women opt for an epidural thus making such a block unnecessary (in my experience as someone who worked in the childbirth field for over two years).

[JeanieC]

Calluna,
Please do not consider doing this!
I had this suggested to me too by my former pain management MD and at the time it was tempting because it could be done locally, and the doctor said it would provide a "definitive" answer as to whether or not I had PN. This was very poor advice as I was to find out by studying this website and tipna. I never went back to that doctor but headed to the PN specialists.
Only a CT guided block can give you a definite answer and those are done in the UK. You can see a picture of how they are done on this site.
I just reread the article by Dr Hibner posted on this forum, and he states that vaginal blocks are not recommended and may even prevent the CT guided ones from being done (can't remember if he said why). Scar tissue maybe?
It will be worth it to wait for the PN experts, and if your doctor doubts this advice, run off the article by Dr Hibner.
Jeanie

[calluna]

Not to worry, JeanieC, I am not taking this route! Because there is so much mesh in my pelvis, it isn't going to be straightforward anyway....