Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain

Dostali Tulunay Kaya

doi:10.4274/atfm.galenos.2021.21548

Research Article

Kronik Perineal Ağrı Yönetiminde İmpar Ganglion Blok Etkinliğinin Değerlendirilmesi

Year 2022, Volume: 75 Issue: 1, 107 - 112, 30.06.2022

Dostali Tulunay Kaya

Abstract

Amaç: Kronik ağrı hayat kalitesi ve fonksiyonel kapasiteyi olumsuz etkileyen bir nedendir. Kronik ağrı sendromlarının pek çoğunda olduğu gibi
perineal (pelvik) kronik ağrı da multimodal yaklaşım gerektirir. Konservatif tedavilere yanıt vermeyen olgularda ganglion impar blokajı, nörolizisi
etkin olabilmektedir. Bu çalışmada kronik perineal ağrılı olgularda ganglion impar blokajının etkinliğini retrospektif olarak değerlendirdik.

Gereç ve Yöntem: Kronik perineal ağrı yakınması (ağrı süresi >6 ay) olan ve floroskopi rehberliğinde ganglion impar blokajı yapılmış 30 hasta
retrospektif olarak değerlendirilmiştir. Pelvik kanser ilişkili kronik perineal ağrısı olan 5 hastada diagnostik blok sonrası nörolizis uygulanmıştır.

Bulgular: Ortalama hasta yaşı 48,6±14,6 (28-75), %63,3 (19) kadın, %36,7 (11) erkek idi. İşlem öncesi ve sonrası vizüel analog skala ve fonksiyonel
bel ağrısı skalası skorlarının karşılaştırmalarında anlamlı azalma gözlenmiştir (p<0,05).

Sonuç: Kronik perineal ağrı tedavisinde ganglion impar blokajı etkin tedavi seçenekleri arasındadır.

Keywords

Pelvik Ağrı, Sinir Bloğu, Ağrı Yönetimi, Kimyasal Nörolizis, Floroskopi

Ethical Statement

Etik Kurul Onayı: Çalışma için 01.09.2020 tarihli ve İ7- 436-20 sayılı Ankara Üniversitesi Girişimsel Olmayan Klinik Çalışmalar Etik Kurulu onayı alınmıştır. Hasta Onayı: Algoloji kliniğimizde girişimsel işlem planlanan hastalardan bilgilendirilmiş gönüllü onam formu alınmaktadır. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir.

Supporting Institution

Project Number

Thanks

References

1. Andromanakos NP, Kouraklis G, Alkiviadis K. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment. Eur J Gastroenterol Hepatol. 2011;23:2-7.
2. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000;25:3072-3079.
3. Nagpal AS, Moody EL. Interventional Management for Pelvic Pain. Phys Med Rehabil Clin N Am. 2017;28:621-646.
4. Raj PP, Erdine S. Interventional Pain Procedures in the Pelvic and Sacral Regions. In: P.P. Raj and S. Erdine, editors. Pain-Relieving Procedures. 1st ed. Chichester, John Wiley&Sons Limited. 2012. pp. 337-383. doi:https://doi. org/10.1002/9781118300480.ch17
5. Plancarte R, Amescua C, Patt RB, Allende S. A751 Presacral neurectomy of the ganglion of walther (Ganglion Impar). Anesthesiology. 1990;73:751.
6. Laxmaiah M. in: Karina G, Michael L, Vikram BP. ed. Essentials of Interventional Techniques in Managing Chronic Pain. 1st ed. Cham: Springer International Publishing: AG; 2018. s. 582-587.
7. Gunduz OH, Sencan S, Kenis-Coskun O. Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study. Pain Med. 2015;16:1278-1281.
8. Fogel GR, Cunningham PY. Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.
9. Pennekamp PH, Kraft CN, Stütz A, et al. Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma. 2005;59:1414-1419.
10. Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10:775- 778. 11. Buttaci JC, Foye PM, Stitik TP. Coccydynia successfully treated with ganglion impar blocks: A case series. Am J Phys Med Rehabil. 2005;84:218.
12. Sencan S, Edipoglu IS, Ulku Demir FG, et al. Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial. Korean J Pain. 2019;32:301-306.
13. Yektaş A. Bupivakain-Lidokain Karışımının Neden Olduğu Sistemik Lokal Anestezik Toksisitesinde İntravenöz Lipid ile Tedavi. Okmeydanı Tıp Dergisi. 2017;33:172-177.
14. Loev MA, Varklet VL, Wilsey BL, et al. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology. 1998;88:1391-1393.
15. Oh CS, Chung IH, Ji HJ, et al. Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology. 2004;101:249-250.
16. Datir A, Connell D. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol. 2010;65:21-25.
17. Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009;25:570-576. doi:10.1097/ AJP.0b013e3181a5f5c7
18. Serdar E. Algolojide Girişimsel İşlemler. 1st ed. İstanbul: Nobel Tıp Kitabevleri Ltd. Şti; 2012.s.58-60.
19. Eker HE, Çok OY, Koçum A, et al. Transsacrococcygeal approach to ganglion impar for pelvic cancer pain: a report of 3 cases. Reg Anesth Pain Med. 2008;33:381-382.
20. Bhatnagar S, Khanna S, Roshni S, et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract. 2012;12:23-32.
21. Demircay E, Kabatas S, Cansever T, et al. Radiofrequency thermocoagulation of ganglion impar in the management of coccydynia: preliminary results. Turk eurosurg. 2010;20:328-333
22. Perkins R, Schofferman J, Reynolds J. Coccygectomy for severe refractory sacrococcygeal joint pain. J Spinal Disord Tech. 2003;16:100-103.
23. Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res. 1984;190:266-272.
24. Grosso NP, van Dam BE. Total coccygectomy for the relief of coccygodynia: a retrospective review. J Spinal Disord. 1995;8:328-330.
25. Hellberg S, Strange-Vognsen HH. Coccygodynia treated by resection of the coccyx. Acta Orthop Scand. 1990;61:463-465.
26. Key JA. Operative treatment of coccygodynia. J Bone Joint Surg.1937;19:759- 764

Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain

Year 2022, Volume: 75 Issue: 1, 107 - 112, 30.06.2022

Dostali Tulunay Kaya

Abstract

Objectives: Chronic pain is a cause that negatively affects the quality of life and functional capacity. As with most chronic pain syndromes, perineal
(pelvic) chronic pain requires a multimodal approach. Ganglion impar blockage and neurolysis may be effective in cases that do not respond to
conservative treatments. In this study, we retrospectively evaluated the effect of ganglion impar block in patients with chronic perineal pain.

Materials and Methods: Thirty patients with chronic perineal pain (duration of pain >6 months), who underwent ganglion impar block under
fluoroscopy, were evaluated retrospectively. Neurolysis was performed after diagnostic block in 5 patients with chronic perineal pain associated
with pelvic cancer.

Results: The average age of the patients was 48.6±14.6 (28-75) years, 63.3% (19) were female, 36.7% (11) were male. Significant differences were
observed in visual analogue scale and oswestry disability index values before and after the procedure (p<0.05).
Conclusion: Ganglion impar blockade should be considered as an effective treatment option in the treatment of chronic perineal pain.

Keywords

Pelvic Pain, Nerve Block, Pain Management, Chemical Neurolysis, Fluoroscopy

Ethical Statement

Supporting Institution

Project Number

Thanks

References

1. Andromanakos NP, Kouraklis G, Alkiviadis K. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment. Eur J Gastroenterol Hepatol. 2011;23:2-7.
2. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000;25:3072-3079.
3. Nagpal AS, Moody EL. Interventional Management for Pelvic Pain. Phys Med Rehabil Clin N Am. 2017;28:621-646.
4. Raj PP, Erdine S. Interventional Pain Procedures in the Pelvic and Sacral Regions. In: P.P. Raj and S. Erdine, editors. Pain-Relieving Procedures. 1st ed. Chichester, John Wiley&Sons Limited. 2012. pp. 337-383. doi:https://doi. org/10.1002/9781118300480.ch17
5. Plancarte R, Amescua C, Patt RB, Allende S. A751 Presacral neurectomy of the ganglion of walther (Ganglion Impar). Anesthesiology. 1990;73:751.
6. Laxmaiah M. in: Karina G, Michael L, Vikram BP. ed. Essentials of Interventional Techniques in Managing Chronic Pain. 1st ed. Cham: Springer International Publishing: AG; 2018. s. 582-587.
7. Gunduz OH, Sencan S, Kenis-Coskun O. Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study. Pain Med. 2015;16:1278-1281.
8. Fogel GR, Cunningham PY. Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54.
9. Pennekamp PH, Kraft CN, Stütz A, et al. Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma. 2005;59:1414-1419.
10. Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10:775- 778. 11. Buttaci JC, Foye PM, Stitik TP. Coccydynia successfully treated with ganglion impar blocks: A case series. Am J Phys Med Rehabil. 2005;84:218.
12. Sencan S, Edipoglu IS, Ulku Demir FG, et al. Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial. Korean J Pain. 2019;32:301-306.
13. Yektaş A. Bupivakain-Lidokain Karışımının Neden Olduğu Sistemik Lokal Anestezik Toksisitesinde İntravenöz Lipid ile Tedavi. Okmeydanı Tıp Dergisi. 2017;33:172-177.
14. Loev MA, Varklet VL, Wilsey BL, et al. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology. 1998;88:1391-1393.
15. Oh CS, Chung IH, Ji HJ, et al. Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology. 2004;101:249-250.
16. Datir A, Connell D. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol. 2010;65:21-25.
17. Agarwal-Kozlowski K, Lorke DE, Habermann CR, et al. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009;25:570-576. doi:10.1097/ AJP.0b013e3181a5f5c7
18. Serdar E. Algolojide Girişimsel İşlemler. 1st ed. İstanbul: Nobel Tıp Kitabevleri Ltd. Şti; 2012.s.58-60.
19. Eker HE, Çok OY, Koçum A, et al. Transsacrococcygeal approach to ganglion impar for pelvic cancer pain: a report of 3 cases. Reg Anesth Pain Med. 2008;33:381-382.
20. Bhatnagar S, Khanna S, Roshni S, et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract. 2012;12:23-32.
21. Demircay E, Kabatas S, Cansever T, et al. Radiofrequency thermocoagulation of ganglion impar in the management of coccydynia: preliminary results. Turk eurosurg. 2010;20:328-333
22. Perkins R, Schofferman J, Reynolds J. Coccygectomy for severe refractory sacrococcygeal joint pain. J Spinal Disord Tech. 2003;16:100-103.
23. Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res. 1984;190:266-272.
24. Grosso NP, van Dam BE. Total coccygectomy for the relief of coccygodynia: a retrospective review. J Spinal Disord. 1995;8:328-330.
25. Hellberg S, Strange-Vognsen HH. Coccygodynia treated by resection of the coccyx. Acta Orthop Scand. 1990;61:463-465.
26. Key JA. Operative treatment of coccygodynia. J Bone Joint Surg.1937;19:759- 764

There are 25 citations in total.

Details

Primary Language	English
Subjects	Pain
Journal Section	Articles
Authors	Dostali Tulunay Kaya 0000-0002-6111-0938
Project Number	-
Publication Date	June 30, 2022
Published in Issue	Year 2022 Volume: 75 Issue: 1

Cite

APA	Tulunay Kaya, D. (2022). Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(1), 107-112. https://doi.org/10.4274/atfm.galenos.2021.21548
AMA	Tulunay Kaya D. Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain. Ankara Üniversitesi Tıp Fakültesi Mecmuası. June 2022;75(1):107-112. doi:10.4274/atfm.galenos.2021.21548
Chicago	Tulunay Kaya, Dostali. “Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 1 (June 2022): 107-12. https://doi.org/10.4274/atfm.galenos.2021.21548.
EndNote	Tulunay Kaya D (June 1, 2022) Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 1 107–112.
IEEE	D. Tulunay Kaya, “Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 1, pp. 107–112, 2022, doi: 10.4274/atfm.galenos.2021.21548.
ISNAD	Tulunay Kaya, Dostali. “Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/1 (June 2022), 107-112. https://doi.org/10.4274/atfm.galenos.2021.21548.
JAMA	Tulunay Kaya D. Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75:107–112.
MLA	Tulunay Kaya, Dostali. “Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 1, 2022, pp. 107-12, doi:10.4274/atfm.galenos.2021.21548.
Vancouver	Tulunay Kaya D. Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75(1):107-12.

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