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Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial
Author(s) -
Labat JJ,
Riant T,
Lassaux A,
Rioult B,
Rabischong B,
Khalfallah M,
Volteau C,
Leroi AM,
Ploteau S
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14222
Subject(s) - medicine , pudendal nerve , local anaesthetic , anesthesia , population , surgery , randomized controlled trial , general anaesthetic , corticosteroid , general anaesthesia , environmental health
Objective To compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment. Design Randomised, double‐blind, controlled trial. Setting Multicentre study. Population 201 patients were included in the study, with a subgroup of 122 women. Methods CT ‐guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A ( n = 68) had local anaesthetic alone, those in Arm B ( n = 66) had local anaesthetic plus corticosteroid and those in Arm C ( n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline. Main outcome measures The primary end‐point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30‐point improvement on a 100‐point visual analogue scale of mean maximum pain over a 2‐week period) or nonresponders. Results Three months’ postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant ( P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C ( P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality‐of‐life criteria. Conclusions Corticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used. Tweetable abstract Steroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.