Transsacrococcygeal approach to ganglion impar block for treatment of chronic coccygodynia after spinal arachnoid cyst removal: A case report.
BACKGROUND
Coccygodynia is a pain in the region of the coccyx that radiates to the sacral, perineal area. The cause of the pain is often unknown. Coccygodynia is diagnosed through the patient's past history, a physical examination, and dynamic radiographic study, but the injection of local anesthetics or a diagnostic nerve blockade are needed to distinguish between somatic, neuropathic, and combined pain. Ganglion impar is a single retroperitoneal structure made of both paravertebral sympathetic ganglions. Although there are no standard guidelines for the treatment of coccygodynia, ganglion impar blockade is one of the effective options for treatment.


METHODS
Here, we report a 42-year-old female patient presenting with severe pain in the coccygeal area after spinal arachnoid cyst removal.


RESULTS
Treatment involved neurolysis with absolute alcohol on the ganglion impar through the transsacrococcygeal junction. Pain was relieved without any complications.


CONCLUSIONS
Our case report offers the ganglion impar blockade using the transsacrococcygeal approach with absolute alcohol can improve intractable coccydynia.
Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Inha University Hospital, Incheon, South Korea.
Young Deog
YD
Cha
Chun Woo
CW
Yang
Jung Uk
JU
Han
Jang Ho
JH
Song
WonJu
W
Na
Sora
S
Oh
Byung-Gun
BG
Kim
D000328:Adult; D016080:Arachnoid Cysts / Q000601:surgery*; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005728:Ganglia, Sympathetic; D006801:Humans; D008279:Magnetic Resonance Imaging; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012445:Sacrococcygeal Region
J Am Acad Orthop Surg. 2004 Jan-Feb;12(1):49-54
14753797
Spine J. 2004 Mar-Apr;4(2):138-40
15016390
J Pain. 2003 Jun;4(5):257-66
14622695
Reg Anesth. 1995 Nov-Dec;20(6):544-5
8608076
Curr Pain Headache Rep. 2013 Jan;17(1):306
23250792
Anesthesiology. 2004 Jul;101(1):249-50
15220800
Anesthesiology. 1990 Aug;73(2):236-9
2382849
Pain. 1986 Mar;24(3):297-311
3515292
J Clin Anesth. 2003 Jun;15(4):282-3
12888164
Spine (Phila Pa 1976). 2000 Dec 1;25(23):3072-9
11145819
Pain Pract. 2005 Jun;5(2):103-10
17177756
Pain. 1990 Apr;41(1):41-46
2352765
Pain Physician. 2007 Sep;10(5):661-6
17876362