Laparoscopic uterosacral nerve block: A fertility preserving option in chronic pelvic pain

Chronic pelvic pain (CPP) can cause extreme physical distress in women and has widespread socio-economic consequences. Nerve root blocks have become a safe and effective treatment modality in multiple specialties in both the diagnosis and treatment of pain. We describe a novel technique of a laparoscopic uterosacral nerve block (USNB) and demonstrate its effectiveness in the treatment of a complex case of CPP. USNB has potential diagnostic, prognostic and therapeutic implications. It should therefore be considered as part of the multi-disciplinary management of women with CPP of suspected uterine origin such as adenomyosis, degenerating fibroids or following myomectomy. Acknowledgments The authors would like to thank Dee Mclean for providing the artwork for Figure 3. Conflict of interest All authors declare no conflicts of interest in this paper.

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Curr Pain Headache Rep 12: 37–41. doi: 10.1007/s11916-008-0008-3 - - Reader Comments - © 2019 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) - Figure 1. Insertion of 20 G, 130 mm pudendal needle containing local anaesthetic and steroid infiltrate supra-pubically - Figure 2. Insertion of needle into uterosacral ligament, 2 cm distal to the insertion into the cervix and 3–5 mm deep (left), and infiltration of the local anaesthetic and steroid mixture - Figure 3. Anatomical representation of optimal sites of infiltration in USNB, marked by “X”