Neuropathic Coccygodynia helped by Steroid Ganglion Impar Block

Longstanding(> 3 months) coccygodynia was helped by transsacrococcygeal ganglion Impar block with 3 mL of 0.5% bupivacaine, 2 mL saline, and 1 mL (40 mg) of methylprednisolone .

Neurol Neurochir Pol. 2018 Aug 28. pii: S0028-3843(18)30252-4. doi:
10.1016/j.pjnns.2018.08.006. [Epub ahead of print]
Ganglion Impar block improves neuropathic pain in coccygodynia: A preliminary
report.
Sencan S et al
https://www.ncbi.nlm.nih.gov/pubmed/30195465

I talked about ganglion impar blocks before:
New Treatment of Perineal / Pelvic Pain – Botox to Ganglion Impar
http://painmuse.org/?p=334

Ganglion Impar Injection For Tailbone Coccydynia
http://painmuse.org/?p=1351

Coccygodynia = Tender Coccyx – Inject Ganglion Impar
http://painmuse.org/?p=4411

Some ideas I found:

  • they used a 22 gauge 3 inch spinal needle and flouroscopy with dye
  • slim people a 30 gauge 1/2 inch needle will work while the longest I have ever needed was a 2 inch 25 gauge needle
  • The best joint to target is the one just below the sacro-coccygeal joint.
  • Instead of imaging, I can put my finger in rectum and feel when needle has just passed the posterior sacrum.
  • they injected 3 mL of 0.5% bupivacaine, 2 mL saline, and 1 mL (40 mg) of methylprednisolone .

Results

ganglion_impar steroid

  • You can also use 80-100 u botulinum:
    New Treatment of Perineal / Pelvic Pain – Botox to Ganglion Impar
    http://painmuse.org/?p=334
  • What even works better is injecting alcohol apparently – no experience there
  • Do I worry about penetrating rectum? Never even close; but I’ve had 8 rectal punctures preformed for assessment of ca prostate while given Ciprofloxin to take so one seems like nothing to me. – if you think you’ve penetrated rectum –  don’t inject and give a cipro…

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