Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

Abstract

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain. However, ganglion impar block combined with pulsed radiofrequency (GIB-PRF) for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance. AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIB-PRF in treating perineal pain. METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016. Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure, and visual analogue scale (VAS) scores at 24 h before and after treatment and 1, 3, and 6 mo later were analyzed to evaluate clinical efficacy. RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients, and no complications occurred. Compared with pretreatment scores, the VAS scores were significantly lower ( P < 0.05) at the four time points after treatment. The VAS scores at 1 and 3 mo were slightly lower than those at 24 h ( P > 0.05) and were significantly lower at 6 mo after treatment ( P < 0.05). There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo ( P > 0.05). CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain. The 6-mo short-term clinical efficacy was favorable, but the long-term outcomes need future study.

Coccydynia

“…The ganglion impar (also referred to as the Walther ganglion) is a sympathetic ganglion situated directly anterior to the coccyx. Serving as the end point of the paravertebral sympathetic chain, the ganglion impar functions to relay nociception and sympathetic innervation of the perineal region 7,8 . Because of its possible role in pain generation of the region, blockage of the ganglion impar has shown significant utility 9 .…”

“…The ganglion impar, or Walther ganglion, is a sympathetic ganglion in the retroperitoneal space located near the sacrococcygeal joint, and coccyx is a target of particular interest for injection therapy 8,17,[26][27][28][29][30][31] (Table II). This block can also be used to inhibit parasympathetic response for perianal sweating 32 .…”