64630 Destruction by neurolytic agent; pudendal nerve

Name of the Procedure:

Destruction by Neurolytic Agent; Pudendal Nerve

Common Names:

• Pudendal Nerve Block
• Pudendal Nerve Ablation

Summary

Destruction by neurolytic agent of the pudendal nerve is a procedure where a chemical agent is used to intentionally damage the pudendal nerve to alleviate chronic pelvic pain. This is often done when other treatments have not been successful.

Purpose

Medical Conditions:

• Chronic pelvic pain
• Pudendal neuralgia

Goals:

• To reduce or eliminate pain by disrupting the nerve signals.
• To improve the patient's quality of life and functional abilities.

Indications

• Persistent and debilitating pelvic pain
• Failure of conservative pain management strategies like medications, physical therapy, or less invasive nerve blocks
• Confirmation of pudendal nerve involvement through diagnostic tests or nerve blocks

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Adjustments to regular medications (e.g., blood thinners) as advised by the healthcare provider.
• Pre-procedure imaging or nerve conduction studies for precise localization of the pudendal nerve.

Procedure Description

1. The patient is positioned to allow access to the pelvic region.
2. Local anesthesia or mild sedation is administered to ensure comfort.
3. Using imaging guidance (such as fluoroscopy or ultrasound), a needle is directed to the pudendal nerve.
4. A neurolytic agent (e.g., phenol or alcohol) is injected around the nerve to destroy its fibers.
5. The needle is removed and the injection site is dressed.

Tools and Equipment:

• Imaging equipment (fluoroscopy or ultrasound)
• Needles and syringes
• Neurolytic chemical agent

Anesthesia:

• Local anesthesia
• Mild sedation, if necessary

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic or surgical center.

Personnel

• Anesthesiologist or pain management specialist (conducting the procedure)
• Nurse (assisting and monitoring the patient)
• Radiologist (if imaging is used)

Risks and Complications

Common Risks:

• Temporary pain at the injection site
• Bruising or bleeding

Rare Risks:

• Infection
• Nerve damage leading to numbness or weakness
• Allergic reaction to the neurolytic agent
• Temporary or persistent worsening of pain

Benefits

• Significant reduction in chronic pelvic pain
• Improved ability to perform daily activities
• Enhanced overall quality of life

Benefits are typically noticed within a few days to weeks post-procedure.

Recovery

• Patients can usually go home the same day.
• Avoid strenuous activities for a few days.
• Follow-up appointments to assess pain relief and adjust treatment if needed.
• Pain relief may last for months or longer, with the possibility of repeat treatments if necessary.

Alternatives

• Conservative pain management (medications, physical therapy)
• Less invasive nerve blocks (without neurolytic agents)
• Surgical interventions for refractory cases (e.g., nerve decompression surgery)

Pros and Cons:

• Conservative management: Non-invasive, but often less effective for severe pain
• Nerve blocks: Temporary relief, might require frequent repetition
• Surgery: Potentially more permanent relief, but involves higher risk and longer recovery

Patient Experience

During the procedure, patients may feel slight discomfort or pressure but should not experience significant pain due to local anesthesia. Post-procedure, temporary soreness at the injection site is common. Effective pain management strategies, including prescribed pain relievers, will be discussed to ensure comfort during recovery.