This procedure is proposed in cases of failure of medical treatment. It involves a simple action that lasts a few minutes with both a diagnostic and a therapeutic goal.
The technique involves infiltrating the cord, as high as possible where it exits the inguinal canal, with a localised long-acting anesthetic without epinephrine. This will elucidate the pain mechanism.
The test is positive when the spontaneous pain and the pain caused by local pressure during a clinical exam (on the epididymis or testicle) disappear for the duration of action of the local anesthetic.
A positive test confirms that the origin of the pain is located downstream of the infiltration site, thus eliminating the possibility of its being located upstream, at the thoraco-lumbar junction for example. If the block, properly performed, is negative with persistent pain, we must consider pathology located in the ilioinguinal or genito-femoral nerve paths, or around spinal level L1.
There is no consensually validated pattern for the repetition of infiltrations in the literature. The block can be performed in outpatient treatment and repeated in case of success associated with a corticosteroid, depending on the duration of the improvement in the pain.