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Eppy Darmadi Achmad - One of the best experts on this subject based on the ideXlab platform.
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perbandingan sensasi nyeri 48 jam dan 42 hari pascasalin menggunakan benang chromic catgut dengan fast absorbing polyglactin 910
Majalah Kedokteran Bandung, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Nyeri perineum akibat robekan yang terjadi pada saat persalinan dapat dirasakan segera setelah melahirkan atau beberapa bulan kemudian, sehingga menyebabkan dispareunia. Episiotomi sebagai profilaktik untuk melindungi integritas dasar panggul merupakan insisi bedah yang lurus dan rapi akan menggantikan laserasi kasar. Sensasi nyeri akibat penjahitan luka episiotomi dapat dikurangi dengan menggunakan benang yang cepat diabsorbsi. Tujuan penelitian ini untuk membandingkan sensasi nyeri perineum pascapenjahitan luka episiotomi menggunakan benang chromic catgut dengan fast absorbing polyglactin 910 terhadap nyeri perineum 48 jam dan 42 hari pascasalin. Penelitian ini dilakukan di Departemen Obstetri dan Ginekologi FK Universitas Padjadjaran-RS Dr. Hasan Sadikin Bandung periode Desember 2009–Maret 2010. Penilaian nyeri menggunakan visual analog scale (VAS) yang dilakukan 48 jam dan 42 hari pascasalin. Lima puluh dari 100 subjek penelitian dilakukan penjahitan dengan benang chromic catgut dan 50 subjek menggunakan benang fast absorbing polyglactin 910. Analisis uji chi-kuadrat 48 jam pascasalin, didapatkan hasil tidak ada perbedaan bermakna pada penggunaan kedua benang tersebut terhadap nyeri perineum (p=0,645). Analisis 42 hari pascasalin didapatkan perbedaan bermakna (p<0,001), kejadian bebas nyeri perineum lebih baik dengan penjahitan menggunakan benang fast absorbing polyglactin 910 (46 kasus atau 92%) dibandingkan dengan pemakaian benang chromic catgut (29 kasus atau 58%). Simpulan, penjahitan luka perineum menggunakan benang fast absorbing polyglactin 910 memberikan kejadian bebas nyeri perineum yang lebih baik dibandingkan dengan benang chromic catgut pada 42 hari pascasalin. [MKB. 2011;43(2):89–92]. Kata kunci : Chromic catgut, fast absorbing polyglactin 910, nyeri perineum Comparative Study of Pain Sensation at 48 hours and 42 Days Postpartum Using Chromic Catgut and Polyglactin 910 Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p<0.001) between both groups, incidence of Perineal Pain free better with fast absorbing sutures using polyglactin 910 (46 cases or 92%) compared with the use of chromic catgut (29 cases or 58%). In conclusion, suturing Perineal wound using fast-absorbing polyglactin 910 provide free events Perineal Pain better than chromic catgut in 42 days. [MKB. 2011;43(2):89–92]. Key words : Chromic catgut, fast-absorbing polyglactin 910, Perineal Pain DOI: http://dx.doi.org/10.15395/mkb.v43n2.49
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Perbandingan Sensasi Nyeri 48 Jam dan 42 Hari Pascasalin Menggunakan Benang Chromic Catgut dengan Fast Absorbing Polyglactin 910
Universitas Padjajaran, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p
Benny Hasan Purwara - One of the best experts on this subject based on the ideXlab platform.
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perbandingan sensasi nyeri 48 jam dan 42 hari pascasalin menggunakan benang chromic catgut dengan fast absorbing polyglactin 910
Majalah Kedokteran Bandung, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Nyeri perineum akibat robekan yang terjadi pada saat persalinan dapat dirasakan segera setelah melahirkan atau beberapa bulan kemudian, sehingga menyebabkan dispareunia. Episiotomi sebagai profilaktik untuk melindungi integritas dasar panggul merupakan insisi bedah yang lurus dan rapi akan menggantikan laserasi kasar. Sensasi nyeri akibat penjahitan luka episiotomi dapat dikurangi dengan menggunakan benang yang cepat diabsorbsi. Tujuan penelitian ini untuk membandingkan sensasi nyeri perineum pascapenjahitan luka episiotomi menggunakan benang chromic catgut dengan fast absorbing polyglactin 910 terhadap nyeri perineum 48 jam dan 42 hari pascasalin. Penelitian ini dilakukan di Departemen Obstetri dan Ginekologi FK Universitas Padjadjaran-RS Dr. Hasan Sadikin Bandung periode Desember 2009–Maret 2010. Penilaian nyeri menggunakan visual analog scale (VAS) yang dilakukan 48 jam dan 42 hari pascasalin. Lima puluh dari 100 subjek penelitian dilakukan penjahitan dengan benang chromic catgut dan 50 subjek menggunakan benang fast absorbing polyglactin 910. Analisis uji chi-kuadrat 48 jam pascasalin, didapatkan hasil tidak ada perbedaan bermakna pada penggunaan kedua benang tersebut terhadap nyeri perineum (p=0,645). Analisis 42 hari pascasalin didapatkan perbedaan bermakna (p<0,001), kejadian bebas nyeri perineum lebih baik dengan penjahitan menggunakan benang fast absorbing polyglactin 910 (46 kasus atau 92%) dibandingkan dengan pemakaian benang chromic catgut (29 kasus atau 58%). Simpulan, penjahitan luka perineum menggunakan benang fast absorbing polyglactin 910 memberikan kejadian bebas nyeri perineum yang lebih baik dibandingkan dengan benang chromic catgut pada 42 hari pascasalin. [MKB. 2011;43(2):89–92]. Kata kunci : Chromic catgut, fast absorbing polyglactin 910, nyeri perineum Comparative Study of Pain Sensation at 48 hours and 42 Days Postpartum Using Chromic Catgut and Polyglactin 910 Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p<0.001) between both groups, incidence of Perineal Pain free better with fast absorbing sutures using polyglactin 910 (46 cases or 92%) compared with the use of chromic catgut (29 cases or 58%). In conclusion, suturing Perineal wound using fast-absorbing polyglactin 910 provide free events Perineal Pain better than chromic catgut in 42 days. [MKB. 2011;43(2):89–92]. Key words : Chromic catgut, fast-absorbing polyglactin 910, Perineal Pain DOI: http://dx.doi.org/10.15395/mkb.v43n2.49
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Perbandingan Sensasi Nyeri 48 Jam dan 42 Hari Pascasalin Menggunakan Benang Chromic Catgut dengan Fast Absorbing Polyglactin 910
Universitas Padjajaran, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p
R Sonny M Sasotya - One of the best experts on this subject based on the ideXlab platform.
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perbandingan sensasi nyeri 48 jam dan 42 hari pascasalin menggunakan benang chromic catgut dengan fast absorbing polyglactin 910
Majalah Kedokteran Bandung, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Nyeri perineum akibat robekan yang terjadi pada saat persalinan dapat dirasakan segera setelah melahirkan atau beberapa bulan kemudian, sehingga menyebabkan dispareunia. Episiotomi sebagai profilaktik untuk melindungi integritas dasar panggul merupakan insisi bedah yang lurus dan rapi akan menggantikan laserasi kasar. Sensasi nyeri akibat penjahitan luka episiotomi dapat dikurangi dengan menggunakan benang yang cepat diabsorbsi. Tujuan penelitian ini untuk membandingkan sensasi nyeri perineum pascapenjahitan luka episiotomi menggunakan benang chromic catgut dengan fast absorbing polyglactin 910 terhadap nyeri perineum 48 jam dan 42 hari pascasalin. Penelitian ini dilakukan di Departemen Obstetri dan Ginekologi FK Universitas Padjadjaran-RS Dr. Hasan Sadikin Bandung periode Desember 2009–Maret 2010. Penilaian nyeri menggunakan visual analog scale (VAS) yang dilakukan 48 jam dan 42 hari pascasalin. Lima puluh dari 100 subjek penelitian dilakukan penjahitan dengan benang chromic catgut dan 50 subjek menggunakan benang fast absorbing polyglactin 910. Analisis uji chi-kuadrat 48 jam pascasalin, didapatkan hasil tidak ada perbedaan bermakna pada penggunaan kedua benang tersebut terhadap nyeri perineum (p=0,645). Analisis 42 hari pascasalin didapatkan perbedaan bermakna (p<0,001), kejadian bebas nyeri perineum lebih baik dengan penjahitan menggunakan benang fast absorbing polyglactin 910 (46 kasus atau 92%) dibandingkan dengan pemakaian benang chromic catgut (29 kasus atau 58%). Simpulan, penjahitan luka perineum menggunakan benang fast absorbing polyglactin 910 memberikan kejadian bebas nyeri perineum yang lebih baik dibandingkan dengan benang chromic catgut pada 42 hari pascasalin. [MKB. 2011;43(2):89–92]. Kata kunci : Chromic catgut, fast absorbing polyglactin 910, nyeri perineum Comparative Study of Pain Sensation at 48 hours and 42 Days Postpartum Using Chromic Catgut and Polyglactin 910 Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p<0.001) between both groups, incidence of Perineal Pain free better with fast absorbing sutures using polyglactin 910 (46 cases or 92%) compared with the use of chromic catgut (29 cases or 58%). In conclusion, suturing Perineal wound using fast-absorbing polyglactin 910 provide free events Perineal Pain better than chromic catgut in 42 days. [MKB. 2011;43(2):89–92]. Key words : Chromic catgut, fast-absorbing polyglactin 910, Perineal Pain DOI: http://dx.doi.org/10.15395/mkb.v43n2.49
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Perbandingan Sensasi Nyeri 48 Jam dan 42 Hari Pascasalin Menggunakan Benang Chromic Catgut dengan Fast Absorbing Polyglactin 910
Universitas Padjajaran, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p
Rizkar Arev M Sukarsa - One of the best experts on this subject based on the ideXlab platform.
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perbandingan sensasi nyeri 48 jam dan 42 hari pascasalin menggunakan benang chromic catgut dengan fast absorbing polyglactin 910
Majalah Kedokteran Bandung, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Nyeri perineum akibat robekan yang terjadi pada saat persalinan dapat dirasakan segera setelah melahirkan atau beberapa bulan kemudian, sehingga menyebabkan dispareunia. Episiotomi sebagai profilaktik untuk melindungi integritas dasar panggul merupakan insisi bedah yang lurus dan rapi akan menggantikan laserasi kasar. Sensasi nyeri akibat penjahitan luka episiotomi dapat dikurangi dengan menggunakan benang yang cepat diabsorbsi. Tujuan penelitian ini untuk membandingkan sensasi nyeri perineum pascapenjahitan luka episiotomi menggunakan benang chromic catgut dengan fast absorbing polyglactin 910 terhadap nyeri perineum 48 jam dan 42 hari pascasalin. Penelitian ini dilakukan di Departemen Obstetri dan Ginekologi FK Universitas Padjadjaran-RS Dr. Hasan Sadikin Bandung periode Desember 2009–Maret 2010. Penilaian nyeri menggunakan visual analog scale (VAS) yang dilakukan 48 jam dan 42 hari pascasalin. Lima puluh dari 100 subjek penelitian dilakukan penjahitan dengan benang chromic catgut dan 50 subjek menggunakan benang fast absorbing polyglactin 910. Analisis uji chi-kuadrat 48 jam pascasalin, didapatkan hasil tidak ada perbedaan bermakna pada penggunaan kedua benang tersebut terhadap nyeri perineum (p=0,645). Analisis 42 hari pascasalin didapatkan perbedaan bermakna (p<0,001), kejadian bebas nyeri perineum lebih baik dengan penjahitan menggunakan benang fast absorbing polyglactin 910 (46 kasus atau 92%) dibandingkan dengan pemakaian benang chromic catgut (29 kasus atau 58%). Simpulan, penjahitan luka perineum menggunakan benang fast absorbing polyglactin 910 memberikan kejadian bebas nyeri perineum yang lebih baik dibandingkan dengan benang chromic catgut pada 42 hari pascasalin. [MKB. 2011;43(2):89–92]. Kata kunci : Chromic catgut, fast absorbing polyglactin 910, nyeri perineum Comparative Study of Pain Sensation at 48 hours and 42 Days Postpartum Using Chromic Catgut and Polyglactin 910 Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p<0.001) between both groups, incidence of Perineal Pain free better with fast absorbing sutures using polyglactin 910 (46 cases or 92%) compared with the use of chromic catgut (29 cases or 58%). In conclusion, suturing Perineal wound using fast-absorbing polyglactin 910 provide free events Perineal Pain better than chromic catgut in 42 days. [MKB. 2011;43(2):89–92]. Key words : Chromic catgut, fast-absorbing polyglactin 910, Perineal Pain DOI: http://dx.doi.org/10.15395/mkb.v43n2.49
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Perbandingan Sensasi Nyeri 48 Jam dan 42 Hari Pascasalin Menggunakan Benang Chromic Catgut dengan Fast Absorbing Polyglactin 910
Universitas Padjajaran, 2011Co-Authors: Benny Hasan Purwara, Rizkar Arev M Sukarsa, R Sonny M Sasotya, Eppy Darmadi AchmadAbstract:Perineal Pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare Perineal Pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The Perineal Pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS). This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant Perineal Pain difference (p=0.645) of both groups but at 42 days the analysis showed a significant difference (p
Thibault Riant - One of the best experts on this subject based on the ideXlab platform.
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Repeated Ganglion Impar Block in a Cohort of 83 Patients with Chronic Pelvic and Perineal Pain.
Pain physician, 2017Co-Authors: Thibault Riant, Jean-jacques Labat, Roger Robert, Amélie Levesque, Stéphane Ploteau, Marie-aimee Perrouin-verbe, Rigaud JAbstract:BACKGROUND The ganglion impar is the first pelvic ganglion of the efferent sympathetic trunk that relays pelvic and Perineal nociceptive messages and therefore constitutes a therapeutic target. OBJECTIVE The objective of this single-center study was to evaluate the effectiveness of 3 repeated ganglion impar blocks in patients with chronic pelvic and Perineal Pain on intention-to-treat. STUDY DESIGN Retrospective single-center study. SETTING We reviewed the medical records of 83 patients with chronic refractory pelvic and Perineal Pain. On intention-to-treat analysis, 62 (74.7%) of the patients received 3 ganglion impar blocks. METHODS Ganglion impar block was performed with 0.75% ropivacaine via a lateral approach over the Co1-Co2 coccygeal joint with computed tomography (CT) guidance. The effectiveness of ganglion impar blocks was evaluated by visual analogue scale (VAS) before and 30 minutes after the blocks. Evaluation at least one month after the block was also performed by Patient Global Impression of Change (PGI-C). RESULTS A total of 220 blocks were performed, 193 (87.7%) of which were considered to be positive with immediate but transient improvement of Pain by more than 50% and complete but transient Pain relief after the procedure in 119 (54.1%) procedures. The variation of the VAS score before and after each block was statistically significant (P < 0.001). Similarly, the VAS score before repeated blocks was significantly improved with decreased Pain intensity over time (P = 0.001). Analysis of the PGI-C one month after the block demonstrated improvement in 41% of cases in the overall population and in 43.6% of cases in the subgroup of 62 patients treated by 3 blocks. LIMITATIONS Retrospective study, short term follow-up. CONCLUSIONS Repeated ganglion impar blocks allowed short-term reduction of Pain intensity with a moderate intermediate-term effect. Ganglion impar appears to be a useful therapeutic target to block the nociceptive message by acting on sensitization phenomena.Key words: Pudendal neuralgia, impar block, Pain, Perineal, coccygodynia.
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infiltration du ganglion impar dans la prise en charge des douleurs Perineales chroniques
Côlon & Rectum, 2015Co-Authors: Stéphane Ploteau, Thibault RiantAbstract:The management of chronic Perineal Pain involves the Impar node block. However, this recent option can be considered only after detailed examination and multidisciplinary team consultation of Perineal Pain. It is part of a global management of the Pain in which are included medications, physiotherapy, transcutaneous electric stimulation and/or surgery. The impar node is an orthosympathetic node more often located anteriorly of the coccyx and behind the rectum. The preferred approach for the block seems to be the lateral access under CT-Scanner. It allows a safe control of the needle position and avoid the intra-articular infection risks.
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new concepts on functional chronic pelvic and Perineal Pain pathophysiology and multidisciplinary management
Discovery Medicine, 2015Co-Authors: Stéphane Ploteau, Jean-jacques Labat, Thibault Riant, Amélie Levesque, R Robert, Julien NizardAbstract:The management of chronic pelvic and Perineal Pain has been improved by a better understanding of the mechanisms of this Pain and an optimized integrated multidisciplinary approach to the patient. The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. In this setting, Painful diseases identified by organ specialists are usually also involved and share several common denominators (triggering factors, predisposing clinical context). These diseases include Painful bladder syndrome, irritable bowel syndrome, vulvodynia, and chronic pelvic Pain syndrome. The Painful symptoms vary from one individual to another and according to his or her capacity to activate Pain inhibition/control processes. Although the patient often attributes chronic Pain to a particular organ (with the corollary that Pain will persist until the organ has been treated), this Pain is generally no longer derived from the organ but is expressed via this organ. Several types of clinical presentation of complex pelvic Pain have therefore been pragmatically identified to facilitate the management of treatment failures resulting from a purely organ-based approach, which can also reinforce the patient's impression of incurability. These subtypes correspond to neuropathic Pain, central sensitization (fibromyalgia), complex regional Pain syndrome, and emotional components similar to those observed in post-traumatic stress disorder. These various components are also often associated and self-perpetuating. Consequently, when pelvic Pain cannot be explained by an organ disease, this model, using each of these four components associated with their specific mechanisms, can be used to propose personalized treatment options and also to identify patients at high risk of postoperative pelvic Pain (multi-operated patients, central sensitization, post-traumatic stress disorder, etc.), which constitutes a major challenge for prevention of these types of Pain that have major implications for patients and society.
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Spinal cord stimulation of the conus medullaris for refractory pudendal neuralgia: a prospective study of 27 consecutive cases.
Neurourology and urodynamics, 2013Co-Authors: Kevin Buffenoir, Jean-jacques Labat, Thibault Riant, B. Rioult, Olivier Hamel, Roger RobertAbstract:Aims Thirty percent of patients with pudendal neuralgia due to pudendal nerve entrapment obtain little or no relief from nerve decompression surgery. The objective was to describe the efficacy of spinal cord stimulation of the conus medullaris in patients with refractory pudendal neuralgia. Methods This prospective study, conducted by two centers in the same university city, described the results obtained on Perineal Pain and functional disability in all patients with an implanted conus medullaris stimulation electrode for the treatment of refractory pudendal neuralgia. Twenty-seven consecutive patients were included by a multidisciplinary pelvis and Perineal Pain clinic between May 2011 and July 2012. Mean follow-up was 15 months. The intervention was an insertion of a stimulation electrode was followed by a test period (lasting an average of 13 days) before deciding on permanent electrode implantation. Maximum and average Perineal Pain scores and the Pain-free sitting time were initially compared during the test and in the long-term (paired t-test). The estimated percent improvement (EPI) was evaluated in the long-term. Results Twenty of the 27 patients were considered to be responders to spinal cord stimulation and 100% of implanted patients remained long-term responders (mean tripling of sitting time, and mean EPI of 55.5%). Conclusions Spinal cord stimulation of the conus medullaris is a safe and effective technique for long-term treatment of refractory pudendal neuralgia. Routine use of this technique, which has never been previously reported in the literature in this type of patient, must now be validated by a larger scale study. Neurourol. Urodynam. 34:177–182, 2015. © 2013 Wiley Periodicals, Inc.