Open AccessTranssacrococcygeal Approach to Ganglion Impar Block for Management Of Chronic Perineal Pain: A Prospective Observational Study
Author(s) -
G. R. Toshniwal
Publication year - 2007
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2007/10/661
Subject(s) - medicine , visual analogue scale , anesthesia , observational study , surgery , ganglion , anatomy , pathology
Background: The ganglion impar or ganglion of Walther is a solitary retroperitonealstructure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectivelymanaged by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach.Design: 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 transsacrococcygealapproach. The Visual Analogue Scale for pain (VAS) at presentation time required for thepain to reduce by 50% to be considered effective and VAS was recorded at different timepoints during 2-month follow-up, and time required to perform the procedure, numberof 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 neurolyticblock patients was 7.8±2 minutes and 5.7±1minutes in therapeutic block patients. Therewere 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.Conclusion: 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 thediagnosis and further plan of management is dependent on the response of the diagnostic block.Key words: Sympathetically mediated perineal pain, ganglion impar block, transsaccrococcygeal approach