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pudendal block

(pudendal anesthesia, saddle block) Block of the pudendal nerves near the ischial spine of the pelvis to provide perineal anesthesia during obstetric procedures, including vaginal birth during the second stage of labor (episiotomy), vaginal repairs, and anorectal surgeries such as hemorrhoidectomies. Perineum is the space between the anus and scrotum in male, or between the anus and vulva in female. It is also safe and effective for urological procedures, including transrectal ultrasound-guided prostate biopsy, transurethral prostatectomy, and catheter-related bladder discomfort. Pudendal nerve is a mixed nerve (both sensory and motor fibers) mainly for the perineum and external genitalia in both sexes. It arises in the pelvic cavity from the sacral plexus (S2-S4), leaves it through the greater sciatic foramen, hooking around the ischial spine, and enters the perineum through the lesser sciatic foramen. (Procedure) Local anesthetic such as lidocaine or chloroprocaine is injected into the pudendal canal where the pudendal nerve is located. Lidocaine is usually preferred for this, because it has a longer duration than chloroprocaine. It aims to block the nerve as it enters the lesser sciatic foramen, 1 cm inferior and medial relative to the attachment of the sacrospinous ligament to the ischial spine. (Anatomical approaches) • transvaginal approach: Common for obstetric and gynecological procedures. • transperineal approach: For anorectal and urological procedures as well as for pudendal neuralgia in males. Uses ultrasound. • perirectal approach: Uses a nerve stimulator to elicit contractions of the external anal sphincter. • transgluteal approach They may be unilateral or bilateral.