Pudendal Nerve Block in Children

Introduction

The pudendal nerve is the major paired nerve of the perineum. It supplies sensation to the genitalia and perineal skin, and motor innervation to the external anal and external urethral sphincters. It is a branch of the sacral plexus (S2 through S4). With ultrasound, the nerve is most easily visualized in the pudendal canal, where it travels with the pudendal artery and vein.

For adults, pudendal blocks are used to provide analgesia for procedures involving the perineal area, to treat pelvic pain associated with conditions such as interstitial cystitis, and to diagnose and treat pudendal neuralgia.

In pediatrics, pudendal blocks compete with caudal blocks when perineal analgesia is needed. Compared to caudal blocks, pudendal blocks offer several advantages for pediatric patients. First, the analgesia lasts for up to 24 hours, whereas caudal analgesia typically dissipates after 6 hours. Second, pudendal blocks target the perineum, and there is no blockade of the lower extremities. Third, the blocks can be successfully performed in pediatric patients of any age.

Pudendal nerve blocks have been shown to be superior to caudal blocks for hypospadias surgery in children, providing superior analgesia of longer duration. Additional indications include but are not limited to circumcisions and the array of genitoplastic procedures.

Pudendal nerve blocks carry a small risk of infection and nerve or vascular injury. Theoretically, such complications have the potential to lead to more serious problems, such as impotence.