Ganglion impar block
The Ganglion impar block injection is a minimally invasive injection procedure that can be used diagnostically or as a therapeutic treatment for chronic pelvic and rectal pain, including tailbone pain (coccydynia).
What conditions are treatable with a Ganglion impar block?
The Ganglion impar block injection can be used diagnostically to determine if further injections in the Ganglion impar will relieve chronic pain the patient is experiencing. If the patient responds positively to the injections that is indicative that the Ganglion impar is indeed the source of their pain. In this case the Ganglion impar block will be used to treat their chronic pain.
Conditions that may do well with a ganglion impar block include perineal pain coming from:
- Distal rectum and anus
- Distal urethra
- Vulva or distal third of vagina
- Cancer that has spread to perineum
- Sacral postherpetic neuralgia
- Other perineal pain conditions
What are the expectations when a patient gets a Ganglion impar block?
Typically the first time a patient receives the Ganglion impar block they have a 50/50 chance of finding relief because it is being used diagnostically and so it is uncertain if the Ganglion impar is the source off their pain. If however, it turns out that the Ganglion impar is indeed the source of their pain, then they stand a substantial chance of experiencing relief from the procedure.
How is the Ganglion impar block performed?
This is a relatively simple outpatient procedure. The patient will lie face down on an exam table and will have their vital signs monitored. The patient will likely be asked to change into a hospital gown to facilitate access to the area to be injected. The area to be injected will be cleansed with sterile solution and numbed with a topical anesthetic. Then a thin needle is inserted with the aid of a fluoroscope (a type of x-ray machine) to insure proper needle placement.
Contrast dye will then be injected into the area to make sure the correct nerves are being treated after which the medications, a mixture of local anesthetic and a corticosteroid are injected. After the injection the patient will be moved to an observation area to be monitored for about 30 minutes for negative reactions to the medications. The entire procedure typically takes less than an hour.
Usually the patient will experience immediate relief from the local anesthetic. This will wear of within a few hours and then it may take a few days before the steroid begins to take effect. The benefit from the steroid may be experienced for several days to several weeks. Maximum benefit may require several treatments after which some patients experience relief for several months.
What risk or side effects are there?
Risk and side effects are minimal, but there are a few that are possible. Slight swelling and light bruising may occur at the injection site as well as a few small drops of blood.
There is a risk of infection if the injection site is not kept clean until it heals; usually that’s just a few days. There is a small risk of tissue damage from the steroid after multiple treatments and a very remote possibility of nerve damage if the needle hits a nerve, but the fluoroscope guidance reduces that risk to nearly zero.
How successful is the Ganglion impar block for the relief of pain?
Several studies have shown 50-60% pain relief for both malignant and non-malignant pain in the perineal area. Relief has been shown to last for weeks to years, with repeat injections offering excellent relief as well (Plancarte et al).
What is the bottom line on the Ganglion impar block?
The bottom line is that if you are experiencing chronic pain in the coccyx and perineal area, then the Ganglion impar block procedure will very likely benefit you.
Discuss your symptoms with your Chicago pain physician at Premier Pain Specilialists to see if this treatment may be right for you.