FAQs on Ganglion Impar Block in Nashville TN

The ganglion impar is a mass of nerves located near the coccyx (tailbone). These nerves relay nociceptive pain signals from the perineal structures to the brain. To provide pain relief in patients who suffer from pain arising from conditions associated with the pelvis and perineum, a ganglion impar block is used.

What conditions are treated with the ganglion impar block?

Conditions commonly treated with the ganglion impar block include chronic perineal pain, coccydynia (tailbone pain), disorders of the color, rectum, or urinary system, abdominal pain, endometriosis, failed back surgery syndrome. In addition, this block is used therapeutically to treat chronic abdominal pain and long-standing pelvic pain.

Why is a ganglion impar block done?

Ganglion impar blockade is used as a diagnostic test that allows the doctor to determine the exact source of pain in the coccyx or perineal region. Pain in these areas can be difficult to pinpoint, as many nerves share common pathways. The sympathetic nerves deliver pain messages from the internal organs (viscera) to the brain, and the ganglion impar is the terminal nerves of this chain.

How does the doctor use the ganglion impar block to diagnose and treat pain?

The outcomes of the ganglion impar block include:

  • The pain does not go away, indicating that the discomfort is not associated with the nerves of the ganglion impar.
  • The pain does go away and stay gone for several hours, which indicates the discomfort arises from the ganglion impar nerves, but the medication was not helpful.
  • The pain leaves following the procedure and continues to improve over the next few weeks.

Will the ganglion impar injection hurt?

The doctor will use a local anesthetic to numb the skin and soft tissues, so you will experience a pinch and burning sensation that lasts a few seconds. The ganglion impar block involves inserting a needle near the spine, so there is slight discomfort, but not severe pain. After the block, the injection site may be tender for a few days, but this gradually improves.

How do I prepare for the ganglion impar block?

A nurse will instruct you of the risks and complications before the procedure, and go over expected side effects. You will sign a consent form, and an IV catheter will be placed in your arm. We request that you bring someone with you to drive you home. Additionally, discuss any medications you are taking with the doctor, as blood-thinning agents must be held for several days prior to the procedure.

How is the ganglion impar block performed?

The ganglion impar block takes around 15 minutes to perform. You will be positioned on your stomach, and the back is cleansed with an antiseptic solution. The doctor numbs the skin and soft tissues with a local anesthetic, and uses x-ray guidance (fluoroscopy) to insert the needles into the lower back region. After the corticosteroid and other medications are injected, the needle is removed, and a bandage is applied.

What can I expect after the procedure?

Many patients experience immediate relief of pain after the ganglion impar block injection, which is due to the local anesthetic. However, the pain may return, and you will experience soreness at the injection site for 12-24 hours. Use ice packs to the lower back for 20 minutes a few times each day to alleviate the discomfort, and rest for the remainder of the day. You are not allowed to shower or soak in a bath until the next day.

What are the side effects, complications, and risks associated with the ganglion impar block?

Corticosteroids can increase blood sugar levels, cause water retention, and lead to sleeping problems. However, these side effects do not occur in everyone, and should they occur, they only last a few days. The risks and complications of the ganglion impar block are rare, but include bleeding, nerve injury, infection, allergic reaction to medications, and/or vessel damage.

What results can I expect after the ganglion impar block?

Depending on which medications are used, pain relief can last for up to one month. However, the shape, size, and location of the ganglion nerves vary from person to person, so it is possible the block may not work. In a recent clinical study involving use of the ganglion impar block for perineal pain, the majority of participants reported reduction in pain scores right after the procedure and lasting for 4 months. Another clinical report found a 75% success rate with this block.

Resources

Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, & Beck H (2009). CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain, 25(7):570-6.

Buttaci CJ, Foye PM, Stitik TP, et al. (2005). Coccydynia successfully treated with ganglion impar blocks: a case series. Am J Phys Med Rehabil, 84(3):218.

Oh CS, Chung IH, Ji HJ, et al. (2004). Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology, 101(1):249-50.

Toshniwal GR, Dureja GP, & Prashanth SM (2007). Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study. Pain Physician, 10(5):661-6.