scholarly journals Conventional Radiofrequency Thermocoagulation vs Pulsed Radiofrequency Neuromodulation of Ganglion Impar in Chronic Perineal Pain of Nononcological Origin

Pain Medicine ◽  
2018 ◽  
Vol 19 (12) ◽  
pp. 2348-2356 ◽  
Author(s):  
Hammad Usmani ◽  
G P Dureja ◽  
Roshan Andleeb ◽  
Nazia Tauheed ◽  
Naiyer Asif
Keyword(s):  
Perineal Pain ◽  
Pulsed Radiofrequency ◽  
Radiofrequency Thermocoagulation ◽  
Chronic Perineal Pain ◽  
Ganglion Impar

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

2012 ◽  
Vol 113 (1) ◽  
pp. 53-57 ◽  
Author(s):  
P. J. Johnston ◽  
Pavel Michálek
Keyword(s):  
Radiation Exposure ◽  
Local Anaesthetic ◽  
Ultrasound Guidance ◽  
Perineal Pain ◽  
Injection Technique ◽  
Presacral Space ◽  
Loss Of Resistance ◽  
Chronic Perineal Pain ◽  
Sacrococcygeal Joint ◽  
Ganglion Impar

The ganglion impar is an unpaired sympathetic structure located at the level of the sacrococcygeal joint. Blockade of this structure has been utilised to treat chronic perineal pain. Methods to achieve this block often involve the use of fluoroscopy which is associated with radiation exposure of staff involved in providing these procedures. We report a combined loss of resistance injection technique in association with ultrasound guidance to achieve the block. Ultrasound was used to identify the sacrococcygeal joint and a needle was shown to enter this region. Loss of resistance was then used to demonstrate that the needle tip lies in a presacral space. The implication being that any injectate would be located in an adequate position. The potential exception would be a neurodestructive procedure as radiographic control of needle tip in relation to the rectum should be performed and recorded. However when aiming for a diagnostic or local anaesthetic based treatment option we feel that this may become an accepted method.

scholarly journals A Challenging Case of Ganglion Impar Block in a Patient with Coccygeal Deformity and Rectal Resection from Metastatic Rectal Cancer

2017 ◽  
pp. 71-77
Author(s):  
Kevin Wong
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Rectal Resection ◽  
World Health ◽  
Perineal Pain ◽  
Patients With Cancer ◽  
Chronic Perineal Pain ◽  
Ganglion Impar Block ◽  
Ganglion Impar

The ganglion impar is a solitary retroperitoneal structure that marks the termination of paravertebral sympathetic chains in the presacral space and receives nociceptive inputs from pelvic organs. Chronic perineal pain (CPP) in patients with advanced cancer can be very debilitating. Ganglion impar block can ameliorate CPP and hence, improve quality of life. Here, we describe the case of a 65-year-old woman with a deformed coccyx caused by childhood trauma and rectal resection from rectal cancer who presented with CPP that substantially affected her quality of life. She was unable to tolerate the side effects of World Health Organization Step 3 analgesics. The patient underwent ganglion impar block that was challenging due to anatomical abnormalities. There was significant immediate and long-term improvement in quality of life and disease coping in our patient after the ganglion impar block. She was able to restore physical activity, decrease the need for potent opioids, and improve sleep quality. We conclude that a ganglion impar block can effectively treat CPP, and in palliative settings, neurolytic ablation can be considered. It is often challenging in patients with cancer due to anatomical abnormalities. Further studies are needed in patients with cancer who have CPP given the suggestion of a better quality of life after ganglion impar block. Key words: Ganglion impar, chronic perineal pain, quality of life, cancer pain, coccyx

scholarly journals Transsacrococcygeal Approach to Ganglion Impar Block for Management Of Chronic Perineal Pain: A Prospective Observational Study

2007 ◽  
Vol 5;10 (9;5) ◽  
pp. 661-666 ◽  
Author(s):  
Dr. Gokul R. Toshniwal
Keyword(s):  
Perineal Pain ◽  
Rank Test ◽  
Presentation Time ◽  
Signed Rank Test ◽  
Chronic Perineal Pain ◽  
The Mean ◽  
Time Required ◽  
Ganglion Impar Block ◽  
Ganglion Impar

Background: The ganglion impar or ganglion of Walther is a solitary retroperitoneal structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively managed 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 transsacrococcygeal approach. The Visual Analogue Scale for pain (VAS) at presentation time required for the pain to reduce by 50% to be considered effective and VAS was recorded at different time points during 2-month follow-up, and time required to perform the procedure, number of 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 neurolytic block patients was 7.8±2 minutes and 5.7±1minutes in therapeutic block patients. There were 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 the diagnosis 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

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