New, simple, ultrasound-guided infiltration of the pudendal nerve - Ultrasonographic technique

PURPOSE: Anesthetic infiltration of the pudendal nerve at the ischial spine can relieve perineal pain in cases of compression or distention. The aim of our study was to look for a real-time, visually controlled infiltration technique using ultrasound. METHODS: Fifty-three volunteers were examined in a prone position using a 3.5-MHz curved-array probe in color-coded Doppler mode. The deep gluteal region was scanned in two perpendicular planes, longitudinal and transverse to the internal pudendal artery. RESULTS: On the transverse planes the ischial spine, the sacrospinous ligament, and the internal pudendal artery were depicted in all but two cases. In 47.2 percent of the cases one trunk of the pudendal nerve was detected directly. Nerves consisting of more than one trunk were not found. The thickness of the nerve ranged between 3.5 and 7 mm. CONCLUSIONS: In almost one-half of the cases a direct ultrasound-guided infiltration of the pudendal nerve is possible. In the remaining cases the nerve can be detected and blocked indirectly, using the ischial spine or the internal pudendal artery as a landmark.