Successful Treatment of Radiation-Induced Proctitis Pain by Blockade of the Ganglion Impar in an Elderly Patient with Prostate Cancer: A Case Report

Khosla, Ankur; Adeyefa, Oludayo; Nasir, Syed

doi:10.1111/pme.12065

Cited by 17 publications

(3 citation statements)

References 8 publications

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“…[ 76 ] Patients often complains of burning sensation or urinary and rectal urgency with ganglion impar associated dysfunction. [ 8 ] Other indications include radiation induced proctitis (rectal pain),[ 77 ] coccygodynia, perianal sweating, and tenesmoid pain. [ 78 ] Plancarte first described the technique for fluoroscopic-guided Ganglion impar block by introducing a bent needle through anococcygeal membrane with a finger inserted in the rectum to guide the needle and prevent rectal injury.…”

Section: Interventional Pain Management Guidelines According To Clinimentioning

confidence: 99%

Evidence-based clinical practice guidelines for interventional pain management in cancer pain

Bhatnagar¹,

Gupta²

2015

Indian J Palliat Care

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Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10–15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients.

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Section: Interventional Pain Management Guidelines According To Clinimentioning

confidence: 99%

Evidence-based clinical practice guidelines for interventional pain management in cancer pain

Bhatnagar¹,

Gupta²

2015

Indian J Palliat Care

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“…Previous studies have shown the effectiveness of ganglion impar block [4][5][6] and radiofrequency thermocoagulation [7] in patients with chronic coccydynia. In addition, ganglion impar block [8,9] and radiofrequency thermocoagulation [10] for perianal pain may also be effective in decreasing pain intensity. Furthermore, there are several case reports which revealed that ganglion impar block may be useful in managing genital pain [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with Successful Responses to Ganglion Impar Block: A Retrospective Study

Kim¹,

Jang²,

Leem³

et al. 2021

Int. J. Med. Sci.

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Background:The ganglion impar (ganglion of Walther) block has been used to manage coccygeal and perineal (perianal and genital) pain due to both benign and malignant causes. However, the factors associated with successful responses to ganglion impar block are unknown. Therefore, in the present study, we aimed to identify the independent factors associated with successful responses to ganglion impar block in patients with chronic pain in coccygeal and perineal regions. Methods: From January 2008 to December 2017, we performed a retrospective review of 106 patients who underwent ganglion impar block. Patients were considered successful responders if they reported a decrease of more than 50% or 4 points on the 11-point (0 = no pain and 10 = worst possible pain) numerical rating scale 1 month after the procedure, while others were considered non-responders. Logistic regression analysis was performed to identify factors independently associated with successful responses at 1 month after the procedure. Results: Multivariable logistic regression analysis showed that cancer-related causes were significantly associated with successful responses at 1 month after ganglion impar block (odds ratio = 2.60, 95% confidence interval = 1.05 to 6.43, P = 0.038). Conclusion: Ganglion impar block may be more effective in cancer-related pain than pain due to benign causes.

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“…Hence, blocking the ganglion impar attenuates this sympathetically mediated pain, leading to a reduction of opioid consumption, lessens constipation, and an improvement in the patients’ quality of life. [4]…”

Section: Introductionmentioning

confidence: 99%

Transcoccygeal neurolytic ganglion impar block for perineal pain: A case series

Nalini

Shivanna

Vishnu

et al. 2018

J Anaesthesiol Clin Pharmacol

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Background and Aims:Chronic perineal pain (CPP) is a poorly localized pain. Its etiology may be benign or malignant. The ganglion impar is a solitary retroperitoneal structure at sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. CPP has been effectively managed by ganglion impar block. Here, we describe a case series of neurolytic ganglion impar block by transcoccygeal approach, analyzing its safety and efficacy.Material and Methods:In this study, five consecutive patients who were given ganglion impar block for CPP using a transcoccygeal approach were followed up for 2 months. The visual analog scale (VAS) score for pain at presentation, time required for the pain to reduce by 50% after the block, VAS during a 2-month follow-up, time required to perform the procedure, number of attempts, and any complications were noted.Results:All the five patients had an excellent pain relief. The mean duration for decrease in VAS by 50% was 14.8 ± 3.1 min. The mean duration to perform the procedure was 10.2 ± 1.5 min. There were no complications. All the patients had clinically significant pain relief with VAS score of 2 till 2-month follow-up.Conclusion:Transcoccygeal ganglion impar block may offer a safe and effective treatment option for CPP as compared to opioids. This approach for neurolysis of the ganglion impar may be recommended in view of the direct course, appreciable end point, and smaller volume of neurolytic requirement.

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Successful Treatment of Radiation-Induced Proctitis Pain by Blockade of the Ganglion Impar in an Elderly Patient with Prostate Cancer: A Case Report

Abstract: Based on this case's success, a prospective study or randomized control trial evaluating the efficacy of the ganglion impar block as a treatment option for chronic anorectal pain secondary to radiation-induced proctitis appears warranted.

Cited by 17 publications

References 8 publications

Evidence-based clinical practice guidelines for interventional pain management in cancer pain

Evidence-based clinical practice guidelines for interventional pain management in cancer pain

Factors associated with Successful Responses to Ganglion Impar Block: A Retrospective Study

Transcoccygeal neurolytic ganglion impar block for perineal pain: A case series

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