title: Blockade of the ganglion impar (walther), using ultrasound and a loss of resistance technique.
abstract: The ganglion impar is an unpaired sympathetic structure located at             the level of the sacrococcygeal joint. Blockade of this structure has been utilised             to treat chronic perineal pain. Methods to achieve this block often involve the             use of fluoroscopy which is associated with radiation exposure of staff involved             in providing these procedures. We report a combined loss of resistance injection             technique in association with ultrasound guidance to achieve the block. Ultrasound             was used to identify the sacrococcygeal joint and a needle was shown to enter this             region. Loss of resistance was then used to demonstrate that the needle tip lies in             a presacral space. The implication being that any injectate would be located in an             adequate position. The potential exception would be a neurodestructive procedure             as radiographic control of needle tip in relation to the rectum should be performed             and recorded. However when aiming for a diagnostic or local anaesthetic based             treatment option we feel that this may become an accepted method.
authors.affiliation: Department of Anaesthetics, Antrim Area Hospital, Antrim, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Johnston
authors.forename: P
authors.initials: P
authors.lastname: Michálek
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001340:Autonomic Nerve Block / Q000379:methods*; D005728:Ganglia, Sympathetic / Q000000981:diagnostic imaging; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D009437:Neuralgia / Q000628:therapy*; D010502:Perineum / Q000294:innervation; D012445:Sacrococcygeal Region; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local