ABSTRACT
Objectives:
Chronic pain is a cause that negatively affects the quality of life and functional capacity. As with most chronic pain syndromes, perineal (pelvic) chronic pain requires a multimodal approach. Ganglion impar blockage and neurolysis may be effective in cases that do not respond to conservative treatments. In this study, we retrospectively evaluated the effect of ganglion impar block in patients with chronic perineal pain.
Materials and Methods:
Thirty patients with chronic perineal pain (duration of pain >6 months), who underwent ganglion impar block under fluoroscopy, were evaluated retrospectively. Neurolysis was performed after diagnostic block in 5 patients with chronic perineal pain associated with pelvic cancer.
Results:
The average age of the patients was 48.6±14.6 (28-75) years, 63.3% (19) were female, 36.7% (11) were male. Significant differences were observed in visual analogue scale and oswestry disability index values before and after the procedure (p<0.05).
Conclusion:
Ganglion impar blockade should be considered as an effective treatment option in the treatment of chronic perineal pain.
Keywords:
Pelvic Pain, Nerve Block, Pain Management, Chemical Neurolysis, Fluoroscopy
References
1Andromanakos NP, Kouraklis G, Alkiviadis K. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment. Eur J Gastroenterol Hepatol. 2011;23:2-7.
2Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000;25:3072-3079.
3Nagpal AS, Moody EL. Interventional Management for Pelvic Pain. Phys Med Rehabil Clin N Am. 2017;28:621-646.
4Raj PP, Erdine S. Interventional Pain Procedures in the Pelvic and Sacral Regions. In: P.P. Raj and S. Erdine, editors. Pain-Relieving Procedures. 1st ed. Chichester, John Wiley&Sons Limited. 2012. pp. 337-383. doi:https://doi.org/10.1002/9781118300480.ch17
5Plancarte R, Amescua C, Patt RB, Allende S. A751 Presacral neurectomy of the ganglion of walther (Ganglion Impar). Anesthesiology. 1990;73:751.
6Laxmaiah M. in: Karina G, Michael L, Vikram BP. ed. Essentials of Interventional Techniques in Managing Chronic Pain. 1st ed. Cham: Springer International Publishing: AG; 2018. s. 582-587.
7Gunduz OH, Sencan S, Kenis-Coskun O. Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study. Pain Med. 2015;16:1278-1281.
8Fogel GR, Cunningham PY. Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.
9Pennekamp PH, Kraft CN, Stütz A, et al. Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma. 2005;59:1414-1419.
10Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10:775-778.
11Buttaci JC, Foye PM, Stitik TP. Coccydynia successfully treated with ganglion impar blocks: A case series. Am J Phys Med Rehabil. 2005;84:218.
12Sencan S, Edipoglu IS, Ulku Demir FG, et al. Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial. Korean J Pain. 2019;32:301-306.
13Yektaş A. Bupivakain-Lidokain Karışımının Neden Olduğu Sistemik Lokal Anestezik Toksisitesinde İntravenöz Lipid ile Tedavi. Okmeydanı Tıp Dergisi. 2017;33:172-177.
14Loev MA, Varklet VL, Wilsey BL, et al. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology. 1998;88:1391-1393.
15Oh CS, Chung IH, Ji HJ, et al. Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology. 2004;101:249-250.
16Datir A, Connell D. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol. 2010;65:21-25.
17Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009;25:570-576. doi:10.1097/AJP.0b013e3181a5f5c7
18Serdar E. Algolojide Girişimsel İşlemler. 1st ed. İstanbul: Nobel Tıp Kitabevleri Ltd. Şti; 2012.s.58-60.
19Eker HE, Çok OY, Koçum A, et al. Transsacrococcygeal approach to ganglion impar for pelvic cancer pain: a report of 3 cases. Reg Anesth Pain Med. 2008;33:381-382.
20Bhatnagar S, Khanna S, Roshni S, et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract. 2012;12:23-32.
21Demircay E, Kabatas S, Cansever T, et al. Radiofrequency thermocoagulation of ganglion impar in the management of coccydynia: preliminary results. Turk Neurosurg. 2010;20:328-333.
22Perkins R, Schofferman J, Reynolds J. Coccygectomy for severe refractory sacrococcygeal joint pain. J Spinal Disord Tech. 2003;16:100-103.
23Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res. 1984;190:266-272.
24Grosso NP, van Dam BE. Total coccygectomy for the relief of coccygodynia: a retrospective review. J Spinal Disord. 1995;8:328-330.
25Hellberg S, Strange-Vognsen HH. Coccygodynia treated by resection of the coccyx. Acta Orthop Scand. 1990;61:463-465.
26Key JA. Operative treatment of coccygodynia. J Bone Joint Surg.1937;19:759-764.
