게시판
| 21KS-021 |
Effectiveness of Ganglion Impar Block on Vulvodynia: Case Series and Results of Mid- and Long-term Follow-up
경북대학교 의과대학 마취통증의학교실
Introduction: Although rarely diagnosed, vulvodynia is a common chronic gynecological disease that affects up to 16% of women. However, there is no known effective treatment. The etiology of vulvodynia is unknown and may be heterogeneous and multifactorial, so it is difficulto improve this condition by using one specific treatment method. There is mounting evidence that vulvodynia has an element of neuropathic pain. Although the role of the sympathetic nervous system in neuropathic pain is controversial, sympathetic nerve blocks have long been used to treat patients with chronic pain, and with good results. A ganglion impar block (GIB), which is one of sympathetic nerve block techniques, may be effective for managing pain and discomfort in patients with vulvodynia.
Case presentation: Four patients who had been suffering from chronic vulvar pain for 6 months to 10 years were referred by gynecologists. The gynecologists have not been able to identify the cause of the chronic vulvar pain, and the symptoms have not improved by conservative therapy with medication. Patients complained of various forms of chronic vulvar pain or discomfort. The initial visual analog scale (VAS) scores were 8 or 9 out of 10 and Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale score were more than 12 out of 24. Through review of gynecological medical records, it was confirmed whether they showed allodynia during the cotton swab test and hyperalgesia to pin-prick test. All patients were diagnosed with vulvodynia. All patients were treated with a GIB under fluoroscopy guidance; once in two patients, three times in one patient, and four times (one alcoholic neurolysis) in the other patient. After the procedures, VAS score was decreased to less than 2 in all patients. Follow-up observations from 6 months to 2 years revealed that three patient’s symptoms completely or nearly completely improved and did not require further treatment, and the remaining one patient was able to control pain with medication only.
Conclusion: In conclusion, GIB can be one of the effective interventional treatment methods for the treatment of vulvodynia, and a multidisciplinary approach and multimodal treatment are essential to treat vulvodynia more effectively.
Case presentation: Four patients who had been suffering from chronic vulvar pain for 6 months to 10 years were referred by gynecologists. The gynecologists have not been able to identify the cause of the chronic vulvar pain, and the symptoms have not improved by conservative therapy with medication. Patients complained of various forms of chronic vulvar pain or discomfort. The initial visual analog scale (VAS) scores were 8 or 9 out of 10 and Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale score were more than 12 out of 24. Through review of gynecological medical records, it was confirmed whether they showed allodynia during the cotton swab test and hyperalgesia to pin-prick test. All patients were diagnosed with vulvodynia. All patients were treated with a GIB under fluoroscopy guidance; once in two patients, three times in one patient, and four times (one alcoholic neurolysis) in the other patient. After the procedures, VAS score was decreased to less than 2 in all patients. Follow-up observations from 6 months to 2 years revealed that three patient’s symptoms completely or nearly completely improved and did not require further treatment, and the remaining one patient was able to control pain with medication only.
Conclusion: In conclusion, GIB can be one of the effective interventional treatment methods for the treatment of vulvodynia, and a multidisciplinary approach and multimodal treatment are essential to treat vulvodynia more effectively.
