Ultrasound-guided interventional procedures for chronic pelvic pain

• Published in: Techniques in regional anesthesia & pain management 2009-07, Vol.13 (3), p.171-178
• Main Authors: Bellingham, Geoff A., MD, FRCPC, Peng, Philip W.H., MBBS, FRCPC
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Chronic pelvic pain; Genitofemoral nerve; Ilioinguinal nerve; Pain Medicine; Piriformis muscle; Pudendal nerve; Ultrasound
• ISSN: 1084-208X; 1558-4534
• DOI: 10.1053/j.trap.2009.06.019

Chronic pelvic pain refers to noncyclical pain localized to the pelvic region for longer than 6 months. There can be numerous causes for pelvic pain excluding visceral pathology. Familiarity with disorders of peripheral nerve and musculoskeletal structures may assist in diagnosis and therapy. This review focuses on three pelvic pain syndromes mediated by somatic nerves: the “border nerve syndrome” (consisting of the ilioinguinal, iliohypogastric, and genitofemoral nerves), the piriformis syndrome, and pudendal neuralgia. Various approaches have been described to block these nerves, ranging from simple blind techniques to the use of open magnetic resonance imaging facilities. The degree of accuracy and safety of the blocks seem to correlate well with the sophistication of the technology employed. The use of ultrasound (US) can consolidate the advantages of many of these methods. US is portable, readily available to pain specialists, and avoids the use of ionizing radiation. It allows the visualization of a wide range of tissues and possibly improves accuracy of needle placement. The purpose of this review is to describe the anatomy and sonoanatomy of the aforementioned nerves. This review will also report the US-guided techniques used to block them for the diagnosis and therapy of chronic pelvic pain.