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The ganglion impar is an unpaired sympathetic structure located atthe level of the sacrococcygeal joint. Blockade of this structure has been utilisedto treat chronic perineal pain. Methods to achieve this block often involve theuse of fluoroscopy which is associated with radiation exposure of staff involvedin providing these procedures. We report a combined loss of resistance injectiontechnique in association with ultrasound guidance to achieve the block. Ultrasoundwas used to identify the sacrococcygeal joint and a needle was shown to enter thisregion. Loss of resistance was then used to demonstrate that the needle tip lies ina presacral space. The implication being that any injectate would be located in anadequate position. The potential exception would be a neurodestructive procedureas radiographic control of needle tip in relation to the rectum should be performedand recorded. However when aiming for a diagnostic or local anaesthetic basedtreatment option we feel that this may become an accepted method.

Blockade of the Ganglion Impar (Walther), Using Ultrasound and a Loss of Resistance Technique