Health Organization for Pudendal Education

The Nantes team is recommending steroids no longer be used in pudendal nerve blocks.

http://www.ncbi.nlm.nih.gov/pubmed/27465823

If you are thinking of having a pudendal nerve block, you might want to show this to your doctor.

Violet

De Bisschop used Corticosteroids only (!) because it help to restore the cell wall impermeability compromised in inflamed nerve cells anso also told me that lidocayne is neuro-toxic (!)

Bupivacaine (marcaine) would be a little better than lidocaine. https://www.ncbi.nlm.nih.gov/pubmed/16135351

There has been some discussion between Dr. Antolak and Prof. Robert's team about the steroids in nerve blocks but I don't have access to reading these. If anyone has access to these journals I would be interested to hear a summary of the conversation if it's worthwhile.

https://www.ncbi.nlm.nih.gov/pubmed/28544719
https://www.ncbi.nlm.nih.gov/pubmed/28544720

Violet

We have been saying for years on this forum that there aren't many patients who post here who have long-term relief from steroid nerve blocks and that there is a risk from getting worse from them. I think there might be some diagnostic value in nerve blocks containing marcaine, although even that is "iffy" because the block doesn't always hit the target, or it may infiltrate other areas of the pelvis. So, I will continue to repeat that I am not a big fan of nerve blocks. In Prof. Robert's article over 10 years ago he said don't get more than 3 steroid nerve blocks due to possible nerve damage. So we have been warned, and now his colleagues are saying no steroids at all.

Violet

Hi Violet and Others,

Your post reminded me that I downloaded that exchange back in July and have been meaning to post it (I have access to a medical library). I attached it now. In a nutshell, Antolak and Chung list reasons why Labat and his colleagues may not have gotten an effect (e.g., injection was not in the best place, limitations in the way they measured the outcome), and Labat and his colleagues note that their results are based on a true experimental design (random assignment to conditions) that was double-blinded (i.e., the best way scientifically to assess the effect of a treatment) and that if Antolak and Chung want to draw conclusions about the effectiveness of their injection technique, they need to do such a test. I buy Labat and his colleagues' argument.

April

I just realized that the exchange I uploaded (from BJOG) is probably copyrighted, so I cannot post it, so I just removed it. If one of the moderators determines that posting is okay, let me know and I'll re-post.

April

Thanks, April. Your summary is perfect.

Violet

Violet and all,

I'm not sure if this helps, but I thought I might contribute to the post. I saw Dr. André Mansano today in São Paulo (who is probably one of the most experienced doctors in Brazil regarding PN/PNE treatment) and I showed him this article. He told me he already knew the study, but in his opinion the problem was that the doctors used way too little steroids. In his view, NB with steroids are a good diagnostic and therapeutic option, specially if tried earlier in the symptoms.

Felipe.

Thanks for that info, Felipe.

In Dr. Robert's original article on PNE he seems to recommend a conservative approach when it comes to steroids -- recommending that you don't have more than 3, so maybe Dr. Mansano is right, I don't know. I think it makes sense to at least try several nerve blocks before trying surgery but I think that steroids aren't completely without risk. They can cause tissue damage, especially when over-used.

How are you doing, Felpie? I'm glad you have some good physicians in your country.

Violet

Thanks for posting this information. It seems like there are very few who get long-term benefit from a nerve block.

For what it's worth, I had an MRI-guided nerve block by Jan Fritz at Johns Hopkins which included an anesthetic and steroid. I got about two weeks of sustained benefit from it. It's the only thing I have had in three years that gave me any relief so I am grateful for that even though it didn't last. I had two previous nerve blocks that were CT-guided and neither of them provided any benefit at all.

RC