Background: The ganglion impar or ganglion of Walther is a solitary retroperitoneal
structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively
managed by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach.
Design: An observational report.
Methods: In this prospective study, 16 consecutive patients who required ganglion impar block for CPP were followed for two months. After informed and written consent,
the ganglion impar was blocked under aseptic precautions, using a transsacrococcygeal
approach. The Visual Analogue Scale for pain (VAS) at presentation time required for the
pain to reduce by 50% to be considered effective and VAS was recorded at different time
points during 2-month follow-up, and time required to perform the procedure, number
of attempts, and any complications were also noted.
Results: All the blocks were effective with a mean duration of 12±3 minutes for 50%
reduction in VAS. The mean duration required to perform the procedure in neurolytic
block patients was 7.8±2 minutes and 5.7±1minutes in therapeutic block patients. There
were no adverse events. All the patients had significant pain relief during 2 month follow-up (P <0.05 compared to baseline). The mean VAS at 2 months was about 2. Statistical analysis was done by using paired “t”/Wilcoxon signed rank test.
Conclusion: A transsacrococcygeal approach for a ganglion impar block is a technically feasible and safe technique. We recommend this technique for neurolysis or radiofrequency ablation of the ganglion impar and for diagnostic blocks, especially when the
diagnosis and further plan of management is dependent on the response of the diagnostic block.
Key words: Sympathetically mediated perineal pain, ganglion impar block, transsaccrococcygeal approach
This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration.
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