determine the efficacy of fluoroscopically-guided ganglion Impar blocks in the management of coccydynia.
Case series reviewing the results from six patients encompassing 20 procedures.
Six patients between the ages of 28 and 76 yr were treated with fluoroscopically-guided ganglion Impar blocks to manage their coccyx pain after more conservative measures (including oral medications, donut cushions etc.) failed to provide adequate relief. The mechanisms of injury included falls, MVA’s, postpartum onset, and possible congenital anomalies, all without evidence of fracture. Each diagnosis of coccydynia was based on history, location of pain and response to previous diagnostic and therapeutic procedures.
The ganglion Impar (ganglion of Walther) is a solitary retroperitoneal sympathetic ganglion that represents the termination of the paired paravertebral sympathetic chains and provides sympathetic innervation of the perineum The use of ganglion Impar blocks are a well documented technique used to relieve coccyx/perineal pain. To our knowledge, this is the largest study confirming the successful use of these fluoroscopically-guided nerve blocks in managing coccydynia.
Each of the 20 injections produced significant relief. The percentage of relief per injection varied from 20–75%, with the majority of patients reporting 50–75% relief per injection, generally lasting weeks to months. Typical for these injections, analgesic benefit in many patients eventually began to wane, but generally the pain still responded well to repeat injection.
Theses results suggest that the application of 0.5% bupivacaine to the ganglion Impar provides significant relief from intractable coccyx generated pain. Often, repeat injections are necessary.