Ultrasound-Guided Ganglion Impar Block: A Technical Report

Lin, Chao-Shun; Cheng, Jen-Kun; Hsu, Yung Wei; Chen, Chien Chuan; Lao, Hsuan Chih; Huang, Chun Jen; Cheng, Peter H.; Narouze, Samer

doi:10.1111/j.1526-4637.2010.00797.x

Cited by 49 publications

(23 citation statements)

References 8 publications

(7 reference statements)

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“…These results were confirmed in a volunteer study where a nerve stimulator was used [3]. In a series of 20 patients with meralgia paresthetica, all had resolution of their symptoms within 2 weeks of injection; however, four patients required repeat injections at 1 week [73] • • Other US-guidance has also been described for injections of the ganglion of impar [75], pudendal nerves [76] and abdominal cutaneous nerves [77]. These studies demonstrated feasibility of the methods rather than superiority of the technique.…”

Section: • Lateral Femoral Cutaneous Nervesupporting

confidence: 61%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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Section: • Lateral Femoral Cutaneous Nervesupporting

confidence: 61%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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“…Following a PubMed literature search defining "ultrasound", "ultrasonography" and "ganglion impar" we found only one reference related to a blockade of the ganglion impar using ultrasound imaging as part of the technique. The article describes the use of ultrasound to identify the sacrococcygeal junction as the initial stage in performing the technique with lateral fluoroscopy utilised to gauge needle depth (Lin et al, 2010). Another article describes a retrospective case series of various sympathetic blocks performed under ultrasound, including ganglion impar block (Bhatnagar et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Blockade of the Ganglion Impar (Walther), Using Ultrasound and a Loss of Resistance Technique

Johnston

Michálek

2012

Prague Med. Rep.

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The ganglion impar is an unpaired sympathetic structure located at the level of the sacrococcygeal joint. Blockade of this structure has been utilised to treat chronic perineal pain. Methods to achieve this block often involve the use of fluoroscopy which is associated with radiation exposure of staff involved in providing these procedures. We report a combined loss of resistance injection technique in association with ultrasound guidance to achieve the block. Ultrasound was used to identify the sacrococcygeal joint and a needle was shown to enter this region. Loss of resistance was then used to demonstrate that the needle tip lies in a presacral space. The implication being that any injectate would be located in an adequate position. The potential exception would be a neurodestructive procedure as radiographic control of needle tip in relation to the rectum should be performed and recorded. However when aiming for a diagnostic or local anaesthetic based treatment option we feel that this may become an accepted method.

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“…By blocking the sympathetics, we can overcome the problem mentioned above. Even though ultrasound [16] can help in administration of the block, we gave it by the classical approach only.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Sacral Postherpetic Neuralgia With Ganglion Impar Block - A Case Report

Parthasarathy

2019

Asian J Pharm Clin Res

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Postherpetic neuralgia (PHN) is one of the most common and important complications of severe varicella-zoster infection, especially occurring in 20% of the elderly patients. A 59-year-old female presented with pain in the right sacral region for the past 3 months. The pain was preceded by herpes zoster. She was diagnosed as a case of Sacral PHN. We administered paramedian approach of ganglion impar block with 10 ml of 0.25% bupivacaine with 8 mg dexamethasone which resulted in immediate adequate pain relief. On follow-up after 8 weeks, the pain score continued to be less with 3/10. No complications were encountered. There was no sensory loss. We conclude that ganglion impar block with a combination of local anesthetic and steroid is a viable treatment option for sacral PHN.

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Ultrasound-Guided Ganglion Impar Block: A Technical Report

Cited by 49 publications

References 8 publications

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Blockade of the Ganglion Impar (Walther), Using Ultrasound and a Loss of Resistance Technique

Successful Management of Sacral Postherpetic Neuralgia With Ganglion Impar Block - A Case Report

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