Ultrasound-guided infiltration of the pudendal nerve: a technical approach for neuropathic pain management

Purpose: Pudendal neuropathy is a debilitating condition often underdiagnosed due to its complex clinical presentation and overlapping symptoms with other pelvic disorders. This review aims to provide an updated synthesis of anatomical, clinical, and technical aspects of ultrasound-guided pudendal nerve infiltration, highlighting its diagnostic and therapeutic relevance in neuropathic pelvic pain. Methods: A narrative analysis was conducted of the pudendal nerve’s anatomy, etiologies of neuropathy, clinical manifestations, diagnostic tools, and image-guided intervention strategies. Particular attention was dedicated to high-resolution ultrasound (HRUS) for anatomical visualization and to the technical considerations underlying perineural injection procedures. Results: Perineural infiltration of the pudendal nerve provides immediate, partial pain relief after anesthetic administration, with the addition of corticosteroids contributing to sustained relief. Ultrasound guidance minimizes complications and has proven superior to traditional landmark-based approaches. The technique demonstrates feasibility, safety, and reproducibility in clinical practice, for both diagnostic and therapeutic purposes. However, clinical results have varied, and repeated sessions or integration with multimodal strategies, including physical therapy, drug therapy, and lifestyle modifications, have often been required. Conclusion: Ultrasound-guided pudendal nerve infiltration is a minimally invasive, safe, and effective technique for both diagnosis and treatment of pudendal neuropathy. While offering rapid pain relief and confirming nerve involvement, infiltrations should be considered as part of a broader multimodal management strategy. Future directions include standardization of protocols, refinement of imaging guidance, and exploration of novel injectates or regenerative therapies to optimize long-term outcomes.