A message from Dr. Attaman regarding nerve blocks

[jaxi123]

Dr Attaman

What is your opinion of pudendal nerve cryoablation ?

[Dr. Jason G. Attaman]

Dr Attaman

What is your opinion of pudendal nerve cryoablation ?

I offer cryoablation of the pudendal nerve though try to reserve it as a last resort as it is a destructive procedure. We have a full size cryoablation unit in the clinic called the Epimed PainBlocker, formerly known as the Wallach painblocker.

[Throwaway2019]

Dr Attaman,

I have had a pudendal block and caudal block and not sure if they helped.

I have a stuck feeling along with skin crawling sensation coming from the 12 oclock position right above my external sphincter that produces skin crawling into the perineum, along with some stinging at the tip of penis.

What would your recommendation be for me? Should I try a peripheral nerve block or trigger point injection?

Thank you

[Dr. Jason G. Attaman]

Hi Throwaway2019;

Did the pudendal block give relief of your symptoms in the first few hours immediately after the procedure?

Oftentimes they will give excellent relief for the first few hours but nothing lasting beyond that.

Some patients interpret that as a failed procedure. However, that is a successful procedure and means that the pudendal nerve IS indeed causing the pain, however no lasting benefit was attained with the steroids injected. Unfortunately the steroids we inject with these pudendal blocks does not typically give the same long term relief as other nerve blocks in other parts of the body. We have no idea why.

Best, Dr. Attaman

[Throwaway2019]

Hi Throwaway2019;

Did the pudendal block give relief of your symptoms in the first few hours immediately after the procedure?

Oftentimes they will give excellent relief for the first few hours but nothing lasting beyond that.

Some patients interpret that as a failed procedure. However, that is a successful procedure and means that the pudendal nerve IS indeed causing the pain, however no lasting benefit was attained with the steroids injected. Unfortunately the steroids we inject with these pudendal blocks does not typically give the same long term relief as other nerve blocks in other parts of the body. We have no idea why.

Best, Dr. Attaman

I am not sure if it did. My pain gets worse as the day goes on. But sometimes I wakeup and it’s not bad. I did not have pain right after but I’m not sure if it was due to all the sedation or if it was the lidocaine.

I have had a very tender and painful obturator internus. I also noticed when stretched my left hamstring that my glute spasms and relieves tightness to my perineum. My pt still can’t figure out what’s going on and it’s been months.

[Dr. Jason G. Attaman]

Hi Throwaway2019;

Did the pudendal block give relief of your symptoms in the first few hours immediately after the procedure?

Oftentimes they will give excellent relief for the first few hours but nothing lasting beyond that.

Some patients interpret that as a failed procedure. However, that is a successful procedure and means that the pudendal nerve IS indeed causing the pain, however no lasting benefit was attained with the steroids injected. Unfortunately the steroids we inject with these pudendal blocks does not typically give the same long term relief as other nerve blocks in other parts of the body. We have no idea why.

Best, Dr. Attaman

I am not sure if it did. My pain gets worse as the day goes on. But sometimes I wakeup and it’s not bad. I did not have pain right after but I’m not sure if it was due to all the sedation or if it was the lidocaine.

I have had a very tender and painful obturator internus. I also noticed when stretched my left hamstring that my glute spasms and relieves tightness to my perineum. My pt still can’t figure out what’s going on and it’s been months.

You might want to repeat the block in that case.
1. Keep an hourly pain log for 8 hours starting immediately after the injection
2. do not use sedation. Not required for pudendal blocks. Can cloud your evaluation of the block.
3. Ask the doctor to use a long acting local anesthetic such as bupivicaine or ropivicaine. This can give you a longer period of numnbess to evaluate the block.