Treatment of radiation-induced cystitis and vulvodynia via a ganglion impar block using a lateral approach under computed tomography guidance: a case report.
10.4097/kjae.2017.70.1.81
- Author:
Jeong Eun LEE
1
;
Kyung Hwa KWAK
;
Seong Wook HONG
;
Hoon JUNG
;
Seung Yeon CHUNG
;
Jun Mo PARK
Author Information
1. Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea. pjm4013@naver.com
- Publication Type:Case Report
- Keywords:
Cystitis;
Nerve block;
Radiation;
Radiotherapy;
Sympathetic ganglia;
Vulvodynia
- MeSH:
Colorectal Neoplasms;
Connective Tissue;
Cystitis*;
Dysuria;
Female;
Fibrosis;
Fluoroscopy;
Ganglia, Sympathetic;
Ganglion Cysts*;
Humans;
Middle Aged;
Needles;
Nerve Block;
Radiotherapy;
Rectal Neoplasms;
Recurrence;
Urination;
Vulvodynia*
- From:Korean Journal of Anesthesiology
2017;70(1):81-85
- CountryRepublic of Korea
- Language:English
-
Abstract:
Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
