Outcome of ganglion impar block in chronic coccydynia

Authors

  • Muhammad Farooq Butt Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Tanveer Ahmed Bhat Department of Orthopaedics, Rajasthan Medical Centre, Tohana, India
  • Zubair Ahmad Lone Department of Orthopaedics, Government Medical College, Handwara, Jammu and Kashmir, India
  • Sanjeev Gupta Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India
  • Abdul Ghani Department of Orthopaedics, Government Medical College Jammu, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232463

Keywords:

Coccydynia, Ganglion impar block, VAS, ODI

Abstract

Background: Chronic coccydynia is an annoying condition and is characterized by pain in the tail bone. Most cases are treated conservatively initially but failed conservative management calls for interventions of various type. One of the interventions in the armamentarium of the orthopaedic surgeon is a ganglion impar block. The present study aimed at assessing the outcome of ganglion impar block in chronic coccydynia.   

Methods: This prospective study of five years duration included 27 patients with chronic coccydynia with failed conservative treatment. Visual analogue score (VAS) and Oswestry disability index (ODI) were used to quantify pain and the improvement in symptoms. Minimum final follow-up was two years.

Results: The mean VAS and ODI scores pre-injection were 5.98±1.86 and 52.13±2.13, respectively. The mean VAS and ODI scores at final follow-up were 2.47±1.65 and 23.59±2.34, respectively. The improvement in the above objective scores was found to be statistically significant with a p=0.00257 for VAS score and 0.00425 for ODI score. One patient developed syncope post-injection and one patient complained of superficial injection site pain which persisted for three weeks. No significant or major complication was encountered.

Conclusions: Ganglion impar block appears to be a very impressive modality of treatment for chronic coccydynia in view of the simplicity, ease and reproducibility of the technique along with minimal complication rates. However, randomized control trials with large sample size are recommended.

References

Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia. An overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14:84‑7.

Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: Role of body mass index and coccygeal trauma. Spine. 2000;25:3072‑9.

Gunduz OH, Sencan S, Kenis‑Coskun O. Pain Relief due to Trans sacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study. Pain Med. 2015;16:1278‑81.

Ellinas H, Sethna NF. Ganglion impar block for management of chronic coccydynia in an adolescent. Paediatr Anaesth. 2009;19:1137‑8.

Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: A pilot study. Spine. 2001;26:E479‑83.

Trollegaard AM, Aarby NS, Hellberg S. Coccygectomy: An effective treatment option for chronic coccydynia: Retrospective results in 41 consecutive patients. J Bone Joint Surg Br. 2010;92:242‑5.

Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407‑14.

Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25:2940‑52.

Wallace MS, Leung AY, McBeth MD. Malignant Pain, Textbook of Regional Anesthesia. Edited by Prithvi Raj. Pennsylvania: Churchill Livingstone Publishers. 2002;585.

Gonnade N, Mehta N, Khera PS, Kumar D, Rajagopal R, Sharma PK. Ganglion impar block in patients with chronic coccydynia. Indian J Radiol Imaging. 2017;27(3):324-8.

Toshniwal GR, Dureja GP. Prasanth SM. Trans sacrococcygeal Approach to Ganglion Impar Block for Management Of Chronic Perineal Pain: A Prospective Observational Study. Pain Phys. 2007;10:661‑6.

Munir MA, Zhang J, Ahmad M. A modified needle‑inside‑needle technique for the ganglion impar block. Can J Anaesth. 2015;51:915‑7.

Nebab EG, Florence IM. An alternate needle geometry for interruption of the ganglion impar. Anesthesiology. 1997;86:1213‑4.

Wemm K Jr., Saberski L. Modified approach to block the ganglion impar (Ganglion of Walther). Reg Anesth. 1995;20:544.

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Published

2023-08-03

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Original Research Articles