[Interest of infiltration of Impar node in rebel vulvodynia: About a series of 8 cases].
BACKGROUND
Vulvodynia is a common and debilitating disease, for which treatments are often of limits efficacy. As the Impar node receives nociceptive afferents from pelvis and perineum, it is a potential therapeutic target to treat pain in this region. The objective of the study was to evaluate the relevance of ropivacaine Impar node infiltration in patients suffering from rebel vulvodyny.


METHODS
This was a retrospective, single-center study. The Impar node infiltrations were performed by a single operator in eight patients suffering from rebel vulvodynia. Ropivacaine and iopamidol were administered in prone position with a lateral approach under scanner. The anaesthetic diagnostic block of the Impar node was positive in all eight patients included in the study. Thereafter these patients benefited of 2 additional therapeutic infiltrations. Subsequently, an infiltration of the node with 100UI of botulinum toxin was performed in two patients with a bilateral approach under scanner. The analgesic efficacy was evaluated by a Visual Analogic Scale (VAS) before, immediately after, and at day 15 following the infiltration. A subjective evaluation of pain comprising the percentage of overall improvement and duration of analgesic efficacy was performed after the third infiltration.


RESULTS
Comparison of the VAS before and immediately after the Impar block showed in the first anesthetic block a significant decrease in pain median VAS from 51/100 to 16/100 (P=0.01). Similarly, for the second block, VAS decreased from 52.5/100 to 15/100 (P=0.02). The maximal pain reported on Day 15, was significantly lower after the third infiltration than that after the first (P=0.03). Five patients reported an overall improvement in their quality of life of over 50%, which lasted an average of six weeks. A long lasting effectiveness was obtained in the two patients who benefited of the botulinum toxin.


CONCLUSIONS
The infiltration of Impar node is an interesting technique for patients suffering of rebel vulvodynia.


METHODS
4.
Pôle gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Centre fédératif de douleur pelvi-périnéales, 8, quai Moncousu, Nantes, France. Electronic address: cardaillac.c@gmail.com.
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Cardaillac
Pôle gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Centre fédératif de douleur pelvi-périnéales, 8, quai Moncousu, Nantes, France.
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S
Ploteau
Centre fédératif de douleur pelvi-périnéales, 8, quai Moncousu, Nantes, France.
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JJ
Labat
Centre fédératif de douleur pelvi-périnéales, 8, quai Moncousu, Nantes, France.
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A
Levesque
Centre fédératif de douleur pelvi-périnéales, 8, quai Moncousu, Nantes, France; Centre d'étude et traitement de la douleur M.-Bensignor CCS, groupe confluent, 2, rue Tabarly, 44200 Nantes, France.
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Riant
D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D000077212:Ropivacaine; D056650:Vulvodynia / Q000188:drug therapy*; D055815:Young Adult
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
Douleur périnéale; Ganglion Impar; Impar node; Infiltration; Perineal pain; Vulvodynia; Vulvodynie