A prospective study to evaluate the efficacy of ultrasound-guided ganglion impar block in patients with chronic perineal pain

Background: The blockade of the ganglion impar has been described to relieve the intractable perineal pain of sympathetic origin in patients with coccydynia. Chronic perineal pain (CPP) has been effectively managed by ganglion impar block. The feasibility, safety, and efficacy of ultrasound (US)-guided ganglion impar block by transsacrococcygeal approach was analyzed in the present study. Methods: A total of 15 patients with CPP were administered US-guided ganglion impar block using out of plane approach. Patients were followed for VAS and quality of life using Karnofsky performance status (KS), Linear Analog Scale Assessment (LASA), and constipation score up to 2 months at different time intervals. Time required to perform the procedure, number of attempts, and any complications were also noted. Results: The mean time required to perform the procedure was 7.67 +/- 1.23 min. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (P < 0.05 compared to baseline VAS). The KS and LASA score improved post block which was statistically significant. The dose of nonsteroidal anti-inflammatory drugs (NSAIDS) decreased from preblock state with statistically significant difference, while the difference in dose of tramadol and morphine was statistically insignificant. Conclusion: US-guided ganglion impar block is technically feasible and safe technique. USG can be used to locate sacrococcygeal junction (SCJ) and facilitate the performance of ganglion impar block. The efficacy and safety of the US-guided ganglion impar blockades needs a proper evaluation in the randomized controlled trials.