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.
1. De Andres J, Chaves S. Coccygodynia: a proposal for an algorithm for treatment. J Pain 2003;4:257-66.
2. Foye PM. New approaches to ganglion impar blocks via coccygeal joints. Reg Anesth Pain Med 2007;3:269.
3. Foye PM, Buttaci CJ, Stitik TP, Yonclas PP. Successful injection for coccyx pain. Am J Phys Med Rehabil 2006;85:783‑4.
4. Fogel GR, Cunningham PY, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Sur 2004;12:49-54.
5. Gupta D, Jain R, Mishra S, Kumar S, Thulkar S, Bhatnagar S. Ultrasonography reinvents the originally described technique for ganglion impar neurolysis in perianal cancer pain. Anesth Analg 2008;107:1390-2.
6. Hodges SD, Eck JC, Humphreys SC. A treatment and outcomes analysis of patients with coccydynia. Spine J 2004;4:138-40.
7. Kodumuri P, Raghuvanshi S, Bommireddy R, Klez Z. Coccydynia - could age, trauma and body mass index be independent prognostic factors for outcomes of intervention? Ann R Coll Surg Engl 2018;100:12-5.
8. Maigne JY, Doursounian L, Chatellier G. Cause and mechanism of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 2000;25:3072-9.
9. Nebab EG, Florence IM. An alternative needle geometry for interruption of the ganglion impar. Anesthesiology 1997;86:1213‑4.
10. Postacchini F, Massobrio M. Idiopathic coccygodynia. Analysis of fifty‑one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 1983;65:1116‑24.
11. Reig E, Abejón D, del Pozo C, Insausti J, Contreras R. Thermocoagulation of the ganglion impar or ganglion of walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Pract 2005;5:103-10.
12. Toshniwal GR, Dureja GP, Prashanth SM. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: A prospective observational study. Pain Physician 2007;10:661-6.
13. Wemm K Jr, Saberski L. Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth 1995;20:544-5.