A novel technique for pudendal nerve block.

Pudendal nerve block is performed to confirm the diagnosis of pudendal neuralgia. Many physicians and patients are hesitant to pursue diagnostic nerve blocks to confirm the diagnosis of pudendal neuralgia secondary to significant patient discomfort, the need for special equipment, and the risk in the traditionally described approach. OBJECTIVE: To describe a novel technique for pudendal nerve block with minimal risk and decreased patient discomfort. DESCRIPTION OF THE TECHNIQUE: With the patient in the prone position, the C-arm is projected in the anteroposterior position until the pelvic inlet is visualized. Subsequently, the ischial spine is highlighted by 5 to 15 degree ipsilateral oblique angulation of the fluoroscope. A 25-gauge 3.5 cm needle is advanced to the tip of the ischial spine where the pudendal nerve transiently leaves the pelvis. The pudendal nerve block is performed at this level. CONCLUSION: We described a new and novel technique to block pudendal nerve under fluoroscopic visualization safely with increased patient comfort.

A new and easy technique to block the stellate ganglion.

The stellate ganglion block has been utilized in a variety of painful conditions ranging from sympathetically mediated pain in the upper extremity to the pain associated with intractable angina. A number of techniques are used to block the stellate ganglion. OBJECTIVE: To describe a new and easy approach to block the stellate ganglion using an oblique view. DESCRIPTION OF A NEW TECHNIQUE: The patient is placed in the supine position with the new slightly extended, and the head rotated slightly to the side opposite the side to be blocked. The fluoroscopic beam is directed in an anteroposterior direction until the C5/6 disc is well visualized. Subsequently, the fluoroscopic beam is rotated obliquely, ipsilateral to the side where blockade is desired. Under real-time imaging, a single pass is made with a 25-gauge spinal needle to contact the bone. At this point, the needle tip is contacting and resting at the junction between the uncinate process and the vertebral body. CONCLUSION: We have described a new approach for stellate ganglion block to be performed under oblique fluoroscopy without technical difficulty or complications.