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El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

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Abstract Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients' anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

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Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients' anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

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PURPOSE: Motor deficits affecting anal sphincter control can severely impair quality of life. Peripheral nerve transfer has been proposed as an option to reestablish anal sphincter motor function. We assessed, in human cadavers, the anatomical feasibility of nerve transfer from a motor branch of the tibialis portion of the sciatic nerve to two distinct points on pudendal nerve (PN), through transgluteal access, as a potential approach to reestablish anal sphincter function. METHODS: We dissected 24 formalinized specimens of the gluteal region and posterior proximal third of the thigh. We characterized the motor fascicle (donor nerve) from the sciatic nerve to the long head of the biceps femoris muscle and the PN (recipient nerve), and measured nerve lengths required for direct coaptation from the donor nerve to the recipient in both the gluteal region (proximal) and perineal cavity (distal). RESULTS: We identified three anatomical variations of the donor nerve as well as three distinct branching patterns of the recipient nerve from the piriformis muscle to the pudendal canal region. Donor nerve lengths (proximal and distal) were satisfactory for direct coaptation in all cases. CONCLUSIONS: Transfer of a motor fascicle of the sciatic nerve to the PN is anatomically feasible without nerve grafts. Donor nerve length was sufficient and donor nerve functionally compatible (motor). Anatomical variations in the PN could also be accommodated.

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Disorders in the course of the neurovascular bed of the sexual neurovascular bundle (NVB) entail problems of gynecological, andrological and urological nature, for example, the state of impotence in men. The aim of the study was to establish a method to determine a projection. The Arteria pudenda interna, Vena pudenda interna and Nervus pudendus (sexual neurovascular bundle or NVB) from the infrapiriform foramen to the Alcock's canal (pudendal canal) in which the pudendal neurovascular bundle runs. Topographic and anatomical study was performed on 15 corpses without organ complex (remote shore): 9-from men and 6-women, aged 36 to 74 years. Each object of study (corpse) included 2 pairs of sexual NVB, a total of 30 investigated. The information obtained on the projection branches of the pudendal nerve, and pudendal internal artery and pudendal internal vein from infrapiriform foramen to the entrance of the pudendal canal. A method for determining the projection of sexual NVB in the gluteal region was developed. The projection of Arteria pudenda interna, Vena pudenda interna and Nervus pudendus from the infrapiriform foramen in the gluteal region and to the entrance of the pudendal canal is determined. The morphometric data necessary for the mathematical equation developed by us for the calculation of the boundaries of the projection of the desired plane in the course of the sexual NVB are obtained . Using these data in the method of mathematical calculation developed by us using the formula C'c' = 0,2679 x (A'G-AD+3), we determined the projection of the figure, in the form of a trapezoid, in the center of which the projection of the sexual NVB is determined.A method for determining the projection of the sexual neurovascular bundle in the gluteal region for diagnosis and therapeutic effects on sexual NPS was developed.

Los trastornos en el curso de las estructuras del haz neurovascular sexual conllevan problemas de naturaleza ginecológica, andrológica y urológica, por ejemplo, el estado de impotencia en los hombres. El objetivo de este estudio fue establecer un método para determinar una proyección de los vasos pudendos internos y el nervio pudendo (haz neurovascular sexual o HNV) desde el foramen infrapiriforme hasta el canal de Alcock (canal pudendo). Se realizó un estudio topográfico y anatómico en 15 cadáveres: 9 hombres y 6 mujeres, entre 36 y 74 años. Se analizaron 30 muestras, cada cadáver incluyó 2 pares de HNV sexuales. Se obtuvo información sobre las ramas de proyección de la arteria, y vena pudenda interna y del nervio pudendo, desde el foramen infrapiriforme hasta la entrada al canal pudendo. Se desarrolló un método para determinar la proyección de NVB sexual en la región glútea. La proyección de la vena pudenda interna y del nervio pudendo se determinó desde el foramen infrapiriformis en la región glútea, hasta la entrada del canal pudendo. Se obtuvieron datos morfométricos necesarios para la ecuación matemática y obtener el cálculo de los límites de la proyección del plano deseado en el curso de la HNV sexual. Usando estos datos se utilizó la fórmula C'c '= 0,2679 x (A'G-AD + 3), y se realizó la proyección de la figura, en forma de trapecio, en el centro del cual se determinó la proyección de la HNV sexual. Se desarrolló un método para la proyección del haz neurovascular sexual en la región glútea, en el diagnóstico y los efectos terapéuticos sobre el NPS sexual.

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El síndrome de atrapamiento del nervio pudendo es una de múltiples causas de dolor pélvico crónico. Hemos realizado una revisión de la literatura sobre su presentación clínica, diagnóstico y tratamiento, con el propósito de conocer los detalles más relevantes de una enfermedad que cada vez está siendo más diagnosticada, con el fin de realizar un abordaje precoz desde un punto de vista integral.

Pudendal neuralgia due to pudendal nerve entrapment is one of the many causes of chronic pelvic pain. A literature was carried out as regards its clinical presentation, and diagnostic and therapeutic approach, in order to understand the most relevant details of this disorder that is increasingly being diagnosed, with the purpose of implementing an early approach from an integral perspective.

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Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

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