title: New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures.
abstract: OBJECTIVE
  Pudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique.
  
  
  METHODS
  We analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA), procaine in 20 patients. A 0.4 × 40 mm needle was handled using a stop-and-go technique while monitoring the patient's discomfort. The needle was placed 1-2 cm laterally to the dorsal introitus. After aspiration, a small amount of LA was applied. After subcutaneous anesthesia, the needle was further advanced step-by-step. Thus, 5 ml could be applied with little discomfort to the patient. Anesthesia in the pudendal target region was the primary endpoint of our analysis.
  
  
  RESULTS
  In 93 of 105 injections (88.6 %), complete perineal anesthesia was achieved with a single injection. 12 injections were repeated. These injections were excluded from the analysis. Severity of injection pain, on visual analog scale (VAS) from 0 to 100, was 26.8 (95 % CI 7.2-46.4). Age (β = 0.33, p < 0.01) and the number of previous injections (β = 0.35, p < 0.01) inversely correlated with injection pain. Injection pain and anesthesia were not affected by BMI, the number and the side of previous injections, or order of injection. A reversible vasovagal reaction was common, but no serious adverse effects occurred.
  
  
  CONCLUSIONS
  Perineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.
authors.affiliation: Gemeinschaftspraxis für Frauenheilkunde und Naturheilverfahren - Dr. med. Stefan Weinschenk, Dr. med. Annerose Scherer, Bahnhofplatz 8, 76137, Karlsruhe, Germany. stefan.weinschenk@med.uni-heidelberg.de.|Department of Gynecological Endocrinology and Fertility Disorders, Women's Hospital University of Heidelberg, Im Neuenheimer Feld 44, 69120, Heidelberg, Germany. stefan.weinschenk@med.uni-heidelberg.de.|The Heidelberg University Neural Therapy Education and Research Group (HUNTER Group), . stefan.weinschenk@med.uni-heidelberg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weinschenk
authors.affiliation: The Heidelberg University Neural Therapy Education and Research Group (HUNTER Group).|Department of Anesthesiology, AMC University of Amsterdam, Meibergdreef 9, Postbus 22660 H1Z-112, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Department of Gynecological Endocrinology and Fertility Disorders, Women's Hospital University of Heidelberg, Im Neuenheimer Feld 44, 69120, Heidelberg, Germany.|The Heidelberg University Neural Therapy Education and Research Group (HUNTER Group).
authors.forename: Thomas
authors.initials: T
authors.lastname: Strowitzki
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009339:Needles; D009407:Nerve Block / Q000295:instrumentation* / Q000379:methods*; D059408:Pain Management; D010147:Pain Measurement; D010502:Perineum / Q000294:innervation; D011247:Pregnancy; D060525:Pudendal Nerve; D014844:Vulva; D056650:Vulvodynia / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000779:Anesthetics, Local
keywords: Nerve block; Neural therapy; Perineal region; Procaine; Therapeutic local anesthesia; Vulvodynia