Ganglion Impar Block: Fluoroscopy and Ultrasound

Blockade of the ganglion impar (also known as ganglion of Walther or sacrococcygeal ganglion) is indicated for evaluating and managing visceral or sympathetic-maintained pain in the coccygeal and perineal area. Ganglion impar neurolysis has been reported in the palliative treatment for malignancies of the pelvis with cancer pain in the perineal area. Ultrasound can be successively used to locate the sacrococcygeal joint (SCJ) and facilitate the performance of ganglion impar block. However, ultrasound can also complement fluoroscopy, as lateral fluoroscopy is still needed to establish safe depth and monitor the spread of the injectate, especially with neurolytic injections.