Treatment of radiation-induced cystitis and vulvodynia via a ganglion impar block using a lateral approach under computed tomography guidance: a case report.
Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Jeong-Eun
JE
Lee
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Kyung-Hwa
KH
Kwak
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Seong Wook
SW
Hong
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Hoon
H
Jung
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Seung-Yeon
SY
Chung
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Jun-Mo
0000-0001-9234-5177
JM
Park
Cystitis; Nerve block; Radiation; Radiotherapy; Sympathetic ganglia; Vulvodynia