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Ganglion Impar Block

Ganglion Impar Block

Facts and Basic Information:

Ganglion impar block is an excellent way to treat chronic, neuropathic perineal pain from visceral and/or sympathetic pain syndromes, especially if they are secondary to malignancy.

If you have vague, poorly localized perineal pain that is frequently accompanied by sensations of burning or urgency you may benefit from this block. However, since the symptoms of burning and urgency, especially if their associated with urination or defecation, may be secondary to a medical condition (i.e. urinary tract infection, sexually transmitted infection, prostate inflammation etc.) it is important to first consult your primary care doctor to make sure you are not experiencing perineal area pain from one of these causes.

A Ganglion of Impar Block is safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain.  This injection is considered to be a type of sympathetic block that can be used in the treatment of sympathetically-mediated pain, pain secondary to malignancy, neuropathic pain and post-surgical pain.

Patients who will benefit from this blockade will frequently present with vague and poorly localized pain in the “seat” region, which is burning in character and frequently accompanied by sensations of urgency with urination and/or defecation.

Ganglion Impar is of particular importance when considering patients who suffer from pain in the pelvic and perineal structures as it provides nociceptive and sympathetic supply to those regions.  It receives sensations from:

  •     Perineum
  •     Distal rectum
  •     Anus
  •     Distal urethra
  •     Distal vagina
  •     Vulva
  •     Coccyx
  •     Scrotum

The block is performed by injecting a small amount of anesthetic onto the ganglion of impar, signals of the sympathetic nervous system (SNS) and pain fibers are interrupted from multiple structures simultaneously, leading to dramatic pain relief.  

This procedure is indicated with great success for treatment of the following pain sources :

  •     Perineal pain, with or without malignancy
  •     Rectal/Anal pain (proctitis)
  •     Distal urethral pain
  •     Vulvodynia
  •     Scrotal pain
  •     Female pelvic/vaginal pain (distal 1/3)
  •     Sympathetically-maintained pain to the region (i.e. Complex Regional Pain Syndrome)
  •     Endometriosis
  •     Vaginal protrusion
  •     Chronic prostatitis
  •     Failed Back Surgery Syndrome (FBSS)
  •     Proctalgia Fugax
  •     Post-surgical thrombosis of the perineal veins
  •     Coccygodynia
  •     Radiation proctitis
  •     Postherpetic neuralgia
  •     Burning and localized perineal pain associated with urgency

Benefits

A ganglion of impar block is a minimally invasive procedure that is easy to perform and can be used to treat visceral, pelvic and genital pain. This injection can be performed in a matter of minutes right in your doctor’s office.

The most important aspect of this procedure is its ability to offer powerful pain relief, even in the presence of malignancy.  Patients can expect anywhere between 50-100% pain relief from this injection. As a variety of pelvic structures have nerve fibers that travel through the ganglion of impar, a block performed here can treat multiple areas of pain simultaneously.

The location of the ganglion of impar makes it ideal for Pulsed Radiofrequency Ablation.

Risks

Due to the ease with which this procedure can be performed, complications are few and far between.  There is a rare potential for bleeding, infection, perforation of the rectum and/or bowel, bladder incontinence, hematoma, and nerve root injury. Given the variable location of the ganglion in relation to the junction, there is the potential for the block to be ineffective, even in the presence of a proper technique and needle placement.  This will necessitate a repeat procedure with a different approach.

As many patients seeking this procedure suffer from malignancy, there some basic concerns which much be considered before opting for this block.

  • Immunocompromized patients are potentially at high risk for infection,  this is of particular relevance in patient with malignancy
  • Patients with metastatic cancer pain may have local masses in the region
  • Patients may have thrombocytopenia secondary to chemotherapy
  • Patients with allodynia could benefit from this injection may also have pain in the very area of the injection which could complicate the ability of one to tolerate the procedure
  • Prone position may be difficult if patient has abdominal distension
  • Patients suffering from radiation proctitis may have skin breakdown in the area, which might contraindicate injection
  • Presence of a rectal fistula

 

If you are suffering from pain in the viscera, pelvis, genitals and/or perineum that has failed to respond to conventional treatment, you may benefit from this truly life changing procedure. 

In blockade of the ganglion of impar can decrease or even eliminate chronic pain originating from the perineum, distal rectum, anus, distal urethra, distal vagina, vulva, coccyx and scrotum – simultaneously.  To learn more about this procedure and find out if you are a candidate, Contact Us to speak with our Board Certified Specialist.

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Ellen McGuire

2015-07-25 22:59:00