[Somatic nerve block in the management of chronic pelvic and perineal pain].
BACKGROUND
Chronic pelvic and perineal pain can be related to a nerve lesion caused by direct or indirect trauma or by an entrapment syndrome, which must then be demonstrated by a test block. The purpose of this article is to review the techniques and modalities of somatic nerve block in the management of chronic pelvic and perineal pain.


METHODS
A review of the literature was performed by searching PubMed for articles on somatic nerve infiltrations in the management of chronic pelvic and perineal pain.


RESULTS
Nerves involved in pelvic and perineal pain are: thoracolumbar nerves (obturator, ilioinguinal, iliohypogastric and genitofemoral) and sacral nerves (pudendal and inferior cluneal branches of the posterior cutaneous nerve of the thigh). Infiltration has a dual objective: to confirm the diagnostic hypothesis by anaesthetic block and to try to relieve pain. Evaluation of the severity and site of the pain before and immediately after the test block is essential for interpretation of the block. The various infiltration techniques for each nerve are described together with their respective advantages, disadvantages and risk of complications.


CONCLUSIONS
Somatic nerve blocks are an integral part of the management of chronic pelvic and perineal pain and are predominantly performed under CT guidance in order to be as selective as possible. Once the diagnosis and the level of the nerve lesion have been defined, more specific therapeutic procedures can then be proposed.
Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. jrigaud@chu-nantes.fr
J
J
Rigaud
T
T
Riant
D
D
Delavierre
L
L
Sibert
J-J
JJ
Labat
D002908:Chronic Disease; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve; D017699:Pelvic Pain / Q000628:therapy*; D010388:Pelvis / Q000294:innervation; D010502:Perineum