Ganglion Impar Block for Chronic Coccydynia

Malik, Sara; Ahmad, Khaleel; Ali, Liaquat

doi:10.55519/jamc-01-11092

Cited by 5 publications

(19 citation statements)

References 12 publications

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“…48 Another study was excluded because the authors only evaluated the severity risk and not the risk of overall shivering. 49 While 2 studies evaluated the effect of prophylactic steroids on shivering in patients undergoing cardiac surgery, 7,27 19 studies were in patients undergoing various noncardiac surgeries, 15,26,[28][29][30][31][32][33][34][35][36][37][38][39][42][43][44][45][46] and 4 studies were performed in women undergoing cesarean deliveries. 14,40,41,47 Perioperative shivering was the primary outcome in 21 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…7,14,15,26,[29][30][31][33][34][35][36][37][38][39][40][41][42][43][45][46][47] However, a power analysis was reported in only 16 studies. 7,14,15,30,31,[33][34][35][36]38,40,41,43,[45][46][47] Dexamethasone was administered intravenously in 18 studies, 7,14,26,27,29,31,32,35,[37][38][39][41][42][43][44]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Dexamethasone was administered intravenously according to body weight in doses of 0.1 to 0.6 mg/kg in 11 studies 7,14,26,29,31,35,37,39,42,43,47 or as standard doses of 8 to 10 mg in 7 studies. 27,32,38,41,[44][45][46] The intrathecal dexamethasone dose used in the 3 studies was 8 mg. 28,36,40 The doses of intravenous hydrocortisone used were 1 to 2 mg/kg. 15,30,33,34 In most studies, the steroids or the controls were administered intravenously before or during induction of anesthesia.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fifteen studies totaling 1750 patients were pooled to evaluate the effect of intravenous dexamethasone versus placebo (normal saline) on shivering risk. 7,14,26,27,31,32,35,38,39,[41][42][43][44][45][46] Intravenous dexamethasone was effective against placebo in decreasing the risk of shivering (RR, 0.49 [95% CI, 0.39-0.63]; P < .00001; I 2 = 72%; Supplemental Digital Content 4, Supplemental Figure 2, http://links.lww.com/AA/E421). In subgroup analysis, administration of intravenous dexamethasone was effective versus placebo in patients undergoing noncardiac surgery under either general (RR, 0.42 [95% CI, 0.34-0.53]; P < .00001; I 2 = 0%) and spinal anesthesia (RR, 0.64 [95% CI, 0.50-0.83]; P = .0008; I 2 = 66%).…”

Section: Comparative Evaluation Of Intravenous Dexamethasone Versus P...mentioning

confidence: 99%

“…Four trials reported patient satisfaction with shivering prophylaxis, 36,38,45,46 and 1 trial reported the QoR. 27 Dexamethasone was the steroid used in these 5 trials.…”

Section: Other Additional Outcomesmentioning

confidence: 99%

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The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Misra¹,

Singh

Sarkar³

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Shivering is common following anesthesia and surgery. Corticosteroids (steroids) have been tried to reduce the risk of shivering, but the evidence in favor of their use is uncertain. The primary objective of this review was to evaluate the effect of steroids on the risk of perioperative (intra- and postoperative) shivering versus controls (placebo and active controls). Additional objectives were to assess the risk of severity of shivering, patient satisfaction with shivering prophylaxis, quality of recovery (QoR), and the risk of steroid-related adverse effects. METHODS: PubMed, Embase, Cochrane Central Registry of Trials, Google Scholar, and preprint servers were searched from inception until November 30, 2022. Randomized controlled trials (RCTs) published in the English language were retrieved, provided they reported on shivering either as a primary or secondary outcome following steroid prophylaxis in adult patients undergoing surgery under spinal or general anesthesia. RESULTS: A total of 3148 patients from 25 RCTs were included in the final analysis. The steroids used in the studies were either dexamethasone or hydrocortisone. Dexamethasone was administered intravenously or intrathecally, while hydrocortisone was administered intravenously. Prophylactic administration of steroids reduced the risk of overall shivering (risk ratio [RR], 0.65 [95% confidence interval {CI}, 0.52–0.82]; P = .0002; I 2 = 77%) as well as the risk of moderate to severe shivering (RR, 0.49 [95% CI, 0.34–0.71]; P = .0002; I 2 = 61%) in comparison to controls. Administration of intravenous dexamethasone (RR, 0.67 [95% CI, 0.52–0.87]; P = .002; I 2 = 78%) and hydrocortisone (RR, 0.51 [95% CI, 0.32–0.80]; P = .003; I 2 = 58%) were effective in shivering prophylaxis. For intrathecal dexamethasone (RR, 0.84 [95% CI, 0.34–2.08]; P = .7; I 2 = 56%), the null hypothesis of no subgroup difference was not rejected (P = .47), preventing definitive conclusions about the efficacy of this route of administration. The prediction intervals for both overall shivering risk (0.24–1.70) and risk of severity of shivering (0.23–1.0) precluded generalization of results in future studies. Meta-regression analysis was used to further explore heterogeneity. Factors like the dose and timing of administration of steroids or the type of anesthesia were not found to be significant. Patient satisfaction and QoR were higher in the dexamethasone groups versus placebo. No increased risk of adverse events of steroids was noted versus placebo or controls. CONCLUSIONS: Prophylactic steroid administration may be beneficial in reducing the risk of perioperative shivering. However, the quality of evidence in favor of steroids is very low. Further well-designed studies are needed for establishing generalization.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Comparative Evaluation Of Intravenous Dexamethasone Versus P...mentioning

confidence: 99%

“…Four trials reported patient satisfaction with shivering prophylaxis, 36,38,45,46 and 1 trial reported the QoR. 27 Dexamethasone was the steroid used in these 5 trials.…”

Section: Other Additional Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Misra¹,

Singh

Sarkar³

et al. 2023

Anesthesia &Amp; Analgesia

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Perioperative administration of dexamethasone to prevent postoperative shivering: a systematic review and meta-analysis of randomized controlled trials

Zhou

Wan

et al. 2023

J Int Med Res

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Objective To evaluate the perioperative administration of dexamethasone to prevent postoperative shivering. Methods We searched PubMed, Embase, Google Scholar, Web of Science, and Cochrane Library for relevant studies of the administration of dexamethasone to prevent postoperative shivering published through 31 May 2023. The primary outcome was the incidence of postoperative shivering. Secondary outcomes comprised the incidence of postoperative nausea, vomiting, and postoperative nausea and vomiting (PONV). RevMan 5.3 software was used for the data analysis. Results We included 12 randomized controlled trials (1276 participants). The results revealed a benefit favoring the perioperative administration of dexamethasone to prevent postoperative shivering (relative risk [RR]: 0.39; 95% confidence interval [CI]: 0.23–0.63), as well as the grade of shivering. The administration of dexamethasone also reduced the incidence of postoperative nausea (RR: 0.54; 95% CI: 0.39–0.73), postoperative vomiting (RR: 0.37; 95% CI: 0.20–0.65), and PONV (RR: 0.50; 95% CI: 0.26–0.95) compared with the control group. Conclusion This study indicated that perioperative administration of dexamethasone prevented postoperative shivering and decreased the incidence of other complications. PROSPERO registration number: CRD42020164488.

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Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Romanukha,

Biloshytsky

2024

Ukr Neurosurg J

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Chronic pelvic pain (CPP) is usually treated conservatively, but in patients who do not respond to treatment, ganglion impar (GI) interventions are used as an alternative way to reduce pain. Objective ‒ to study the course of pain syndrome and functional status in patients with coccygodynia (CD) and CPP during the application of minimally invasive interventions on GI. Materials and methods. The analysis of the results of 56 interventions on GI in 50 patients was performed. Inclusion criteria were patients with coccyx pain for ≥3 months aged 23 to 71 years (mean age 47.9±14.8years) who did not respond to conservative treatment methods. 15 (35.7%) of the study participants were male and 27 (64.3%) were female. Interventions were performed on the patients according to five different methods, which were divided into two groups: the first group (n=34) ‒ GI block (GIB) with a local anesthetic and a steroid (patients with CD in whom medical conservative methods of treatment were not effective). The second group (n=14) consisted of persons with recurrent pain syndrome, resistant forms of CD and CPP, including after previously performed steroid injections: n=2 – neurolysis of GI with ethyl alcohol; n=2 – neurolysis of GI by phenol; n=3 – radio frequency modulation of GI; n=7 – radiofrequency ablation of GI. Results. 14.0% of all study participants had post-traumatic CD (history of falling on the coccyx), the vast majority of 86.0% ‒ idiopathic CD. Pain intensity was significantly lower post-intervention compared to baseline VAS mean of 7.6±1.5 cm: 2.5±0.9 cm one-week post-procedure, 1.5±1.9 cm one month, 1.3±1.5 cm three months, 2.1±1.2 cm six months. The average score according to the Karnovsky Scale (KS) before and after the procedure was 73.3±6.3% and 83.9±4.9%, respectively. Conclusions. Interventions on ganglion impar are an effective method of treating patients with coccygodynia of various etiology, which significantly reduce pain according to the VAS scale (p<0.001) and improve the quality of life according to the KS (p<0.001) in dynamics after 1, 3, 6 months. Minimally invasive interventions on ganglion impar make it possible to reduce tissue trauma, to quickly recover for patients after the procedure, and to minimize any complications. In the first and second groups of the study, there was a decrease in the pain on the VAS from 8.0 cm to 2.0 cm (p<0.0001) and from 7.0 cm to 2,7 cm (p<0.001) before and after the procedure, respectively. In the first and second groups of the study, there was an improvement in the indicator of functional status according to the KS from 70% (95% сonfidence interval (CI) 60‒90%) to 90% (95% CI 70‒100%, p<0.0001) and from 70% (95% CI 70‒90%) to 90% (95% CI 80‒100%, p=0.001) before and after the procedure, respectively.

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Ganglion Impar Block for Chronic Coccydynia

Cited by 5 publications

References 12 publications

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Perioperative administration of dexamethasone to prevent postoperative shivering: a systematic review and meta-analysis of randomized controlled trials

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

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