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Ganglion Impar Block Injections

The ganglion impar nerve is located behind the coccyx (tail bone) and is the only unpaired autonomic ganglion in the body, marking the end of two sympathetic chains. Blocking the nerve is a popular and effective way to treat visceral and/or sympathetic neuropathic perineal pain symptoms, especially if they are secondary to cancer.


You might be a good candidate for a ganglion impar block if you have poorly localized perineal pain and have already checked with your primary care doctor to assure that your pain is not secondary to other medical conditions (including UTIs, STDs, or prostate inflammation). Because the ganglion impar innervates several organs, a block can be beneficial for pain stemming from a number of organs, including: distal rectum, anus, vulva, distal urethra, perineum, or the distal third of the vagina.


Utah Ganglion Impar Blocks Treatment


In 1990, the ganglion impar block was originally described and performed. Since then, the technique has been modified and improved by researchers to both increase the patient's comfort and to ease the performance of the procedure for the physician. Of the many approaches that can be taken, the most common method of performing a ganglion impar block is called the trans-sacrococcygeal approach, which is comparatively simpler and more effective than other approaches.


This technique usually takes about 15 minutes and is performed using fluoroscopic guidance. The doctor may recommend intravenous sedation to make the patient more comfortable during the procedure. The patient lies on their stomach with a pillow under the pelvis in order to help straighten out the natural curve of the lumbar spine. After being prepped and sterilized, a local anesthetic will be administered to the specified area. When the patient is satisfactorily anesthetized, the physician (using fluoroscopic guidance) will maneuver the needle into place and inject a contrast dye to assure correct placement. When the position is confirmed, a diagnostic block is often preformed to determine whether the patient's pain is visceral or somatic; this is followed by a therapeutic block. After the procedure is finished, the doctor will monitor pain and vital signs.


Risks and Benefits of a Impar Block Injection


As with any medical procedure, there are both risks and benefits that must be considered before deciding to undergo treatment. The ganglion impar block, however, has a very low occurrence of negative side-effects. Although there are potential risks involved with a ganglion impar block (including misplaced needles, bleeding, nerve damage, or paralysis), in current literature there isn't a single report of major complications involved with this procedure. A ganglion impar block can be beneficial to people with a number of ailments.


The procedure is used to treat perineal pain originating from the distal third of the vagina, the vulva, the distal urethra, the anus, the distal rectum and the perineum. It is also helpful in treating perineal pain secondary to testicular ablation, vaginal protrusion, spinal cord malformations, sacral post-herpetic neuralgia, failed back surgery syndrome, postsurgerical thrombosis of perineal veins, and cancers that have metastasized to perineum (including testicular, prostate, cervical, colorectal, etc.). Although not common, the procedure can also be performed to reduce perineal hyperhidrosis.



Outcome and Success of an Impar Block


When the procedure is finished, the doctor will usually have the patient wait from ten to thirty minutes before they are released from the practice. A successful procedure will be marked by significant pain relief. The duration of this relief varies from person to person. Some patients have relief for weeks and others report a reduction of pain for years. The location, size, and shape of the ganglion impar nerve varies from person to person. Because of this, there is a possible risk of an ineffective block. If no relief is obtained from the initial approach (usually transsacrococcygeal), the physician will likely elect to try another approach that is better suited to the patients anatomy.

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