In:
Pain Management Case Reports, American Society of Interventional Pain Physicians
Abstract:
Every year, thousands of women undergo
surgeries to treat severe female pelvic organ prolapse or stress urinary incontinence. Unfortunately,
chronic pelvic pain may result from these surgical interventions, especially if mesh was
used. This case report describes the management of 2 patients that presented at an outpatient
pain center with chronic pelvic pain secondary to obturator neuralgia.
The first patient was a 45-year-old with history of vaginal reconstruction surgery, who presented
to the pain clinic with s evere pain in the medial
thigh radiating to the perineal area. This pain had been present for months and persisted despite
use of oral opioids, neuropathic pain medications, and topical agents. The patient had been seen
and evaluated by neurology and urogynecology post operatively, but they could not ascertain the
cause of her chronic complaints. The second patient was a 47-year-old with pain in the medial
thigh and left side of her groin after transobturator sling procedure. Her pain was resistant to oral
neuropathic pain medications (gabapentin and pregabalin) primarily due to the patient’s inability
to tolerate therapeutic doses of these medications. She was referred to neurology and nerve conduction
studies was notable for decreased conduction in the left obturator nerve.
Both patients chose to try ultrasound guided obturator nerve blocks as a diagnostic and treatment
modality. After the injection, the patients endorsed significant relief of their pain that persisted through
their 3 month follow-up appointments leading to improved functionality in many aspects of their
daily lives. In a clinical situation like the one described
above, the pain practitioner should more readily consider use of these blocks in the outpatient
setting for pelvic pain patients whose symptoms are suggestive of obturator neuralgia.
Key words: Chronic pelvic pain, obturator nerve block, mesh pain, obturator neuralgia
Type of Medium:
Online Resource
ISSN:
2575-9841
DOI:
10.36076/pmcr.2018/2/93
Language:
English
Publisher:
American Society of Interventional Pain Physicians
Publication Date:
2018
detail.hit.zdb_id:
3018839-8
detail.hit.zdb_id:
3018840-4
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