GANGLION IMPAR BLOCK IN PATIENTS WITH CHRONIC COCCYDYNIA

Abstract

Objective: Coccydynia refers to pain in the terminal segment of the spine caused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively; however, in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studied the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management. Materials and Methods: We retrospectively reviewed 39 patients who underwent fluoroscopy-guided trans-sacro-coccygeal ganglion impar block between April 2014 and April 2016. We included four patients with coccygeal fractures. General demographics and parameters including operative time, length of hospital stay, mean time to return to work, complications, and recurrences were recorded. Clinical outcomes were evaluated using Visual Analog Scale (VAS) for pain. Results: The study included 25 (64.1%) female and 14 (35.9%) male patients. The mean age of the patients was 48.6 years (range, 14 to 81 years). Coccydynia was the leading symptom in this series. The mean duration of symptoms was 16 months (between 1 and 36 months). All patients were followed up for a 12-month period. A significant decrease was found in the mean VAS scores. The mean preoperative VAS score was found to be 8 whereas the mean postoperative VAS score at the 12th month was found to be 0.3. Conclusion: This study recommends the trans-sacro-coccygeal "needle inside needle" technique for local anesthetic block of the ganglion impar for pain relief in patients with chronic coccydynia. This should be integrated with rehabilitative measures including ergonomic modification for prolonging pain-free period.