If you suffer from chronic pain in the groin, perineal, or genital region, one option for treatment is the ganglion impar block. This block is often used when conservative measures fail to relieve pain.
Who is a candidate for the ganglion impar block?
The ganglion impar block is an easy, safe procedure used to treat pelvic, genital, visceral, perineal, and anal pain. This injection procedure is a type of sympathetic block used to treat sympathetically-mediated pain, neuropathic pain, malignancy pain, and post-surgical pain. Candidates are those who complain of poorly localized pain in the “seat” region, which is often associated with urgencies to defecate or urinate, and the pain is often described as burning or searing.
What is the ganglion impar?
The ganglion impar is a nerve bundled that is part of the sympathetic nervous system. These nerves provide sensation to the pelvic and perineal structures. A diagnostic block is used to determine the source of pain, and a therapeutic block is used to treat the pain.
What conditions are treated using the ganglion impar block?
The ganglion impar block is used to treat:
- Distal urethral pain
- Rectal pain
- Rectal or anal pain
- Scrotal pain
- Vaginal protrusion
- Chronic prostatitis
- Proctalgia fugax
- Postherpetic neuralgia
- Radiation proctitis
What happens at the consultation visit?
You will meet with the pain management specialist to discuss your symptoms and have additional tests. The doctor will take a medical history and conduct a physical examination. Once you and the doctor decide on having the ganglion impar procedure, the doctor schedules your procedure.
How do I prepare for the ganglion impar block procedure?
Because a sedative is used, you should arrange to have someone drive you home. In addition, wear loose-fitting clothing to the medical facility, and leave all valuables at home. When you arrive at the surgical center, a nurse reviews the procedure risks and benefits, has you fill out paperwork, and asks you to sign a consent form. After you change into a gown, the nurse places an IV line in your arm. You are positioned face-down, and a mild sedative is given through your IV line. After your lower back region is cleaned with an antiseptic, the surgeon numbs the skin and deeper tissues with an anesthetic.
How is the ganglion block performed?
When an anesthetic (bupivacaine or lidocaine) and/or neurolytic agent (alcohol or phenol) are/is used, the procedure involves inserting a needle near the ganglion impar using real-time x-ray. Once the medication is instilled, the needle is removed. If radiofrequency energy is used, a needle with catheter is inserted, the needle is then removed, and the special RF cannula is inserted through the catheter. Once the RF energy is used to ablate/destroy the nerves, the device is removed.
How is the diagnostic ganglion impar block done?
The diagnostic block is done the same as the therapeutic block. This procedure is used to assess the source of the pain. The pain management physician will choose the radiofrequency lesioning technique or neurolysis to treat the pain for a longer duration.
Does the ganglion impar block work?
The transacrococcygeal method of the ganglion impar block was used to treat coccydynia in a clinical study. There were 41 people in the study who had a mean age of 47 years. In addition, patients had chronic tailbone pain. When given the block, 90% reported symptom relief at the 6-month follow-up appointment. Based on low complication rates and decreased pain scores, researchers concluded that the ganglion impar block was useful for treating chronic coccydynia.
Adas C, Ozdemir U, Toman H, et al. (2016). Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia. J Pain Res, 7(9), 1173-1177.
Datir A, Connell D: CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clinical Radiology 2010; 65: 21-25.
Toshniwal GR, Dureja GP, Prahanth SM: Trans-sacrococcygeal approach to ganglion impar block for management of chronic perineal pain: A prospective observational study. Pain Physician 2007; 10: 661-666.