Pudendal

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Pudendal Nerve Block

1. Introduction

• Overview of the pudendal nerve and relevance in pediatric anesthesia
• Typical indications (e.g., circumcision, hypospadias, anorectal surgery, urologic procedures)
• Advantages compared to caudal or dorsal penile/clitoral blocks

2. Anatomy and Related Structures

• Anatomy of the pudendal nerve and its terminal branches: a cadaver study
• Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament
• Variations in the branching of the internal pudendal artery in the ischioanal fossa

3. Techniques and Approaches

3.1 Ultrasound-Guided Techniques

• Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach
• New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique
• Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain
• Randomized controlled trial comparing pudendal nerve block under ultrasound and fluoroscopic guidance
• Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal: Description of Anatomy and Clinical Technique
• OA-SPA Pediatric Anesthesia Virtual Grand Rounds: Ultrasound-guided Pudendal Nerve Block for Children in the Lithotomy Position

3.2 Nerve Stimulator and Landmark Approaches

• Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy
• Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain

4. Pediatric and Clinical Applications

4.1 Pediatric Urologic Surgery

• How I Do It: The pudendal nerve block for pediatric ambulatory urologic surgery

4.2 Hypospadias and Circumcision

• The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children
• Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial
• A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomized controlled trial

5. Other Clinical Studies and Adult Data (Contextual)

• A randomized controlled trial of pudendal nerve block for pain relief after episiotomy

6. Summary of Evidence

• Comparative outcomes in pediatric vs adult data
• Analgesic duration, success rates, and complications
• Role of ultrasound guidance in improving safety and efficacy

7. References and Further Reading

• Full citation list with PubMed/DOI links for easy reference