Relieving nonresponsive, chronic perineal pain with ganglion impar block
The ganglion impar block has been shown to relieve chronic perineal pain nonresponsive to any conservative treatment. This unpaid sympathetic ganglion is located in the retroperitoneal midline at the level of sacrococcygeal junction. Pulsed radiofrequency utilises a pulsed current at approximately 42 degrees centigrade for a period of 4-6 minutes, which does not result in sufficient tissue injury. Fluoroscopically guided ganglion impar block and pulsed radiofrequency may offer a safe and effective way of improving non-cancer perineal pain.
Ganglion impar blocks are performed with a 25-gauge needle using a sacrococcygeal junction approach with a needle-through-needle technique. The pain score is measured using a visual analogue scale before and after treatment. A positive result to the diagnostic local anaesthetic block is an indication to performed pulsed radiofrequency to obtaining a long acting relief.
Blocking the ganglion impar and Pulsed Radiofrequency have demonstrated relief of intractable perineal pain.