title: Pudendal nerve block in HDR-brachytherapy patients: do we really need general or regional anesthesia?
abstract: OBJECTIVE
  In male patients, the pudendal block was applied only in rare cases as a therapy of neuralgia of the pudendal nerve. We compared pudendal nerve block (NPB) and combined spinal-epidural anesthesia (CSE) in order to perform a pain-free high-dose-rate (HDR) brachytherapy in a former pilot study in 2010. Regarding this background, in the present study, we only performed the bilateral perineal infiltration of the pudendal nerve.
  
  
  METHODS
  In 25 patients (71.8 ± 4.18 years) suffering from a high-risk prostate carcinoma, we performed the HDR-brachytherapy with the NPB. The perioperative compatibility, the subjective feeling (German school marks principle 1-6), subjective pain (VAS 1-10) and the early postoperative course (mobility, complications) were examined.
  
  
  RESULTS
  All patients preferred the NPB. There was no change of anesthesia form necessary. The expense time of NPB was 10.68 ± 2.34 min. The hollow needles (mean 24, range 13-27) for the HDR-brachytherapy remained on average 79.92 ± 12.41 min. During and postoperative, pain feeling was between 1.4 ± 1.08 and 1.08 ± 1.00. A transurethral 22 French Foley catheter was left in place for 6 h. All patients felt the bladder catheter as annoying, but they considered postoperative mobility as more important as complete lack of pain. The subjective feeling was described as 2.28 ± 0.74. Any side effects or complications did not appear.
  
  
  CONCLUSIONS
  Bilateral NPB is a safe and effective analgesic option in HDR-brachytherapy and can replace CSE. It offers the advantage of almost no impaired mobility of the patient and can be performed by the urologist himself. Using transrectal ultrasound guidance, the method can be learned quickly.
authors.affiliation: Department of Urology and Urooncology, University of Essen Medical School, Hufelandstraße 55, 45122, Essen, Germany. marcus.schenck@uni-due.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Schenck
authors.forename: Catarina
authors.initials: C
authors.lastname: Schenck
authors.forename: Herbert
authors.initials: H
authors.lastname: Rübben
authors.forename: Martin
authors.initials: M
authors.lastname: Stuschke
authors.forename: Tim
authors.initials: T
authors.lastname: Schneider
authors.forename: Andreas
authors.initials: A
authors.lastname: Eisenhardt
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D060525:Pudendal Nerve