Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.
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.


METHODS
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+/-1 minutes 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.


CONCLUSIONS
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.
Toshniwal
Gokul R
GR
All India Institute of Medical Sciences, Indian Spinal Injuries Centre, New Delhi, India. grtosh1@gmail.com
Dureja
G P
GP
Prashanth
S M
SM
D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005728:Ganglia, Sympathetic / Q000601:surgery*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000188:drug therapy* / Q000601:surgery*; D019800:Phenol / Q000008:administration & dosage; D011446:Prospective Studies; D012445:Sacrococcygeal Region / Q000601:surgery*; D012597:Sclerosing Solutions / Q000008:administration & dosage
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D012597:Sclerosing Solutions; D019800:Phenol; D008775:Methylprednisolone; D002045:Bupivacaine