• Stefan Weinschenk, Markus W Hollmann, and Thomas Strowitzki.
• Gemeinschaftspraxis für Frauenheilkunde und Naturheilverfahren - Dr. med. Stefan Weinschenk, Dr. med. Annerose Scherer, Bahnhofplatz 8, 76137, Karlsruhe, Germany. stefan.weinschenk@med.uni-heidelberg.de.
• Arch. Gynecol. Obstet. 2016 Apr 1; 293 (4): 805-13.

PurposePudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique.Patients And MethodsWe analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA), procaine in 20 patients. A 0.4 × 40 mm needle was handled using a stop-and-go technique while monitoring the patient's discomfort. The needle was placed 1-2 cm laterally to the dorsal introitus. After aspiration, a small amount of LA was applied. After subcutaneous anesthesia, the needle was further advanced step-by-step. Thus, 5 ml could be applied with little discomfort to the patient. Anesthesia in the pudendal target region was the primary endpoint of our analysis.ResultsIn 93 of 105 injections (88.6 %), complete perineal anesthesia was achieved with a single injection. 12 injections were repeated. These injections were excluded from the analysis. Severity of injection pain, on visual analog scale (VAS) from 0 to 100, was 26.8 (95 % CI 7.2-46.4). Age (β = 0.33, p < 0.01) and the number of previous injections (β = 0.35, p < 0.01) inversely correlated with injection pain. Injection pain and anesthesia were not affected by BMI, the number and the side of previous injections, or order of injection. A reversible vasovagal reaction was common, but no serious adverse effects occurred.ConclusionPerineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.

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