FAQs on Ganglion Impar Block in Philadelphia

The ganglion impar block involves injecting a local anesthetic onto the ganglion impar, which is a group of nerves located behind the tailbone (coccyx). Chronic pain occurs due to over-activity of these nerves.

What is the purpose of the ganglion impar block?

The ganglion impar block is used to reduce pain in the perineal area, which includes the distal rectum, lower urethra, vulva, and perineum. In addition, this block is used to alleviate pain caused by cancer.

What is actually injected with this block?

The injection usually involves a mixture of a local anesthetic and a corticosteroid. Anesthetics include bupivicaine and lidocaine, and steroids include methylprednisolone and triamcinolone.

What happens before the ganglion impar block procedure?

Before the procedure, you should notify the doctor of any blood-thinning medications you are taking, as these must be held for a few days. When you arrive at the medical center, you should arrange for someone to drive you home, sign a consent form, and receive detailed risk/benefit instructions. An IV catheter is placed in your arm, so you can receive a sedative and other necessary fluids and medications.

How is the ganglion impar block performed?

The ganglion impar block procedure involves inserting a needle into the skin and deeper tissues to first numb the region. Using fluoroscopy (x-ray guidance), a needle is inserted and positioned near the ganglion impar nerves. Once in position, medication is instilled onto the nerves.

What can I expect after the procedure?

Immediately after the ganglion impar block injection, you will notice your extremities feeling numb, slightly heavy, and weak. The injection site will be sore for 2-3 days, due to the mechanical process of the needle insertion. We advise you to rest for the remainder of the day and return to usual activities as tolerated. Unless there are complications, you may return to work the following day.

How many ganglion block impar procedures are required?

Many patients find relief after just one procedure. However, the duration of pain relief vary from patient to patient. The pain management specialist may recommend a repeat injection if you have good results.

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

The procedure is safe and effective. However, with any minimally invasive procedure, a few risks, side effects, and complications are associated with the procedure. The risks include spinal nerve damage, bleeding, infection, puncture of an organ, or blood vessel damage. Side effects are soreness of the very low back, leg weakness, numbness of the extremities, and dizziness.

What conditions are treated with this procedure?

Sympathetic nerve pain responds to the ganglion impar block. This pain occurs due to:

  • Non-malignant pelvic pain syndromes
  • Chronic perineal pain
  • Chronic pancreatitis
  • Upper abdominal pain
  • Spinal cord malformations
  • Failed back surgery syndrome
  • Poor blood supply to the nerves
  • Sacral post-herpetic neuralgia

What is the efficacy rate of the ganglion impar block?

One clinical study proved that the ganglion impar block had a 70-90% success rate. In another research report, 74% of patients reported complete or partial symptom relief, with a technical success rate of 100%.

Resources

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.

Lin CS, Cheng JK, Hsu YW, Chen CC, Lao HC, et al. Ultrasound-guided ganglion impar block: A technical report. Pain Medicine. 2010;11:390-394.

Menon R, Swanepoel A. Sympathetic blocks. Contin Educ Anaesth Crit Care Pain. 2010;10(2):88-92.

Toshniwal G, Dureja GP, Prashanth SM. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: A prospective observational study. Pain Physician.2007;10:661-666.