Outpatient local anaesthetic temporary SNS: X marks the spot: P011


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Abstract

Aim:Despite the obvious advantages of PNE under local anaesthesia, concerns over discomfort, difficulty localising the sacral foramen, sterility and reliance on a sensory rather than motor response has restricted its use. This report examines the feasibility of outpatient PNE under local anaesthesia.Method:Three bony landmarks were used: tip of the coccyx, sacro-coccygeal joint and midline between posterior superior iliac spines. Correct S3 placement of the needle was confirmed by an anal, perineal or vaginal patient sensory response.Results:Thirty of 32 patients (94%) underwent PNE, reasons for failure wereprocedural pain (1) and bilateral failure to cannulate S3 or S4 (1). These two patients had a successful test wire put in under general anaesthesia. All patients were able to go home within 1 hour. There were no lead infections, one lead dislocation and one lead fracture. Twenty-six patients (81%) had a successful PNE test.Conclusion:The high success rate confirms the reliability of these bony reference points without fluoroscopic guidance using a sensory response and is comparable to that reported for PNE under general anaesthesia using a motor response. PNE can reliably be undertaken in apractical inexpensive outpatient setting under local anaesthetic without adversely influencing outcome.

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