Pudendal Nerve Block and Rectal Ca | Nerve Blocks, Neurolysis, and Rizotomies
Pudendal Nerve Block and Rectal Ca | Nerve Blocks, Neurolysis, and Rizotomies
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The pudendal nerve block is also sort of a deeper block that can help in perineal pain. It's the block that's used actually by the obstetricians in child delivery if you're not having an epidural. They do an internal block through the cervix and vagina

and basically block the pudendal nerve there just medial to the acetabulum and the ischium. We can do this block under CT guidance and you can see I've done the block here on the right hand image from a posterior approach, avoiding the sciatic nerve, obviously,

and injecting a little bit of contrast and then the bupivacaine and the lidocaine and you can get a nice deep block. This is an actual case of a patient who had profound rectal cancer invading the perineum and actually passing through the skin, unfortunately.

The patient was in extreme pain, couldn't get out of bed, just absolutely miserable. And by doing the block and then neurolysis where we actually inject alcohol, you can actually improve this patient's pain syndrome and that in fact is what happened.

The other thing I mentioned earlier that we're going at Mass General is jet ventilation. And the jet ventilation is a very cool concept that's been around since the 1970s, but hasn't been employed in IR in mass.

So there's been studies that I showed you. But that creates a static field, so you get these little short bursts of 15 mls at 100 times per minute. And that creates actually a static field in the internal organs, the lungs.

And imagine a radiologist, if he knew about the static field, no patient moving, no apnea, he just goes in there and does the procedure. That actually increases the procedure accuracy, decreases radiation exposure.

Actually lesions that were thought to not be amenable to you know, some cryoablation, are now amenable to cryoablation. So if there's a lesion at the base of the lung, you traditionally couldn't get it. But now with this jet ventilation,

we brought it downstairs, we actually treat that lesion, treat that patient and offer, other treatment benefits, or modalities that the patient wouldn't otherwise be a candidate for. And you can see the jet ventilations over there. In one of the screens, the middle screen

you can see us putting the jet catheter, and then the jet ventilator's right there. But this has been, this technology has been in existence since 1970. It's old to us, but it's novel now in IR. And I think it's gonna gain traction.

These have been looked at and there's meta analysis of over a thousand patients that shows that this is a highly effective way to control pain if offered early. The later you offer this, these blocks,

the less effective they are. But 70 to 90% of patients experienced either partial or complete pain relief at some time prior to their death.

So a couple of things. So we got this state back,

and it was important in IR suite, it's patient satisfaction. You know CG CAHPS, HCAHPS, that's very important for patients how they felt during a procedure, right. The other thing that's very important in IR right now is the opioid epidemic right, pain.

Prescription of opioids. And actually one of these, these two things anesthesiologists are good at.

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