Trigger Point Injection of Bupivacaine Hydrochloride for Chronic Nonvisceral Pelvic Pain in Women

Choo, Myung Soo; Park, Hyung Keun; Park, Taehan

Abstract

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.