Comparison of block and pulsed radiofrequency of the ganglion impar in coccygodynia

Abstract

Background/aim: Ganglion impar block is used for the treatment of chronic coccygodynia. Pulsed radiofrequency (PRF) of the ganglion impar is a promising novel technique. The aim of this study was to determine and compare the efficacy of the blockade and PRF of the ganglion impar. Materials and methods: Thirty-nine consecutive patients diagnosed with coccygodynia and treated with a blockade or PRF of the ganglion impar were included in this retrospective study. We compared the ganglion impar block (GIB) group (n = 25) with the ganglion impar pulsed radiofrequency (GIPRF) group (n = 14) in terms of pain intensity and patient satisfaction. We applied a numeric pain rating scale (NPRS) and a Likert scale (LS). Results: The NPRS scores in both groups had improved significantly from baseline at 3 weeks and at 3 and 6 months. However, in the sixth month, pain levels in the GIPRF group remained good, but they had returned to almost initial levels in the GIB group. Correspondingly, there were significant differences between groups in NPRS and patient satisfaction scores at 6 months (P ˂ 0.05). Conclusion: PRF neuromodulation provides significantly longer pain relief and reduces the risk of recurrence of pain in chronic coccygodynia as compared with blockade of the impar ganglion.

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

“…Similarly, Gopal et al at 6 and 12 months post-procedure and Karaman et al at a mean of 8.9 ± 6.4 months post-procedure reported [ 50% reduction in VAS scores in 75% of patients [42,43]. Lastly, Sir et al reported a greater length of effect using PRF compared to anesthetic block [44]. Mean numeric pain rating scale (NPRS) scores were similarly reduced compared to baseline in both groups at 3 months post-procedure, but only in the PRF group at 6 months post-procedure.…”

“…These studies (excluding case series and reports) are summarized in Tables 1, 2, 3, 4, and 5. Studies involving RF treatment of the SNS primarily focused on its efficacy in CRPS (Table 1) [28][29][30][31][32][33][34][35][36], pain in the perineal region (Table 2) [37][38][39][40][41][42][43][44][45][46][47][48], headache and facial pain (Table 3) [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], and oncologic and non-oncologic abdominal pain (Table 4) [64][65][66][67][68][69][70][71]…”

“…receiving CRF at a mean of 2.2 months post-procedure [37]. Focusing specifically on coccydynia, Results for the PRF group in the study performed by Usmani et al were contradicted by four other studies also reporting on the use of PRF applied to the ganglion impar, but these studies focused specifically on coccydynia [41][42][43][44]. Atim et al reported [ 50% VAS reduction at 3 weeks and 6 months post-procedure in 90% and 81% of patients, respectively, with 57% and 24% of patients experiencing excellent and good results, respectively, as measured by a subjective questionnaire [41].…”

“…Mean numeric pain rating scale (NPRS) scores were similarly reduced compared to baseline in both groups at 3 months post-procedure, but only in the PRF group at 6 months post-procedure. Patient satisfaction also favored PRF on the Likert scale (LS) (71.4% vs. 48%) [44].…”

Lower EUS-guided ganglion impar blockade

“…3 When the pain is refractory to conservative medical therapy, including neuromodulators, localized nerve injections may be offered. Traditionally, anesthesia pain clinics may perform this procedure through an anococcygeal approach using a bent needle, 4 a lateral paramedian coccygeal approach under fluoroscopic guidance, 5 or transdiscal through the sacroccygeal disc, 6 typically using a combination of local anesthetic (bupivacaine or lidocaine), normal saline solution, and steroid (triamcinolone or methylprednisolone). Improvement in pain as determined through symptom surveys occurs in 41% to 100% of cases at 1 to 2 months 5,7 ; however, potential risks include bleeding, pain (particularly when using a bent needle or corkscrew approach), discitis, and injury to the surrounding pelvic organs.…”