Modifled Approach through the Sacrococcygeal Junction to Block the Ganglion Impar

Song, Sun Ok; Kwon, Oh Deuk; Kim, Seong Ki

Abstract

Ganglion impar lies immediately anterior to the sacrococcygeal junction and blockade of the ganglion is used to treat anorectal and perineal pain. Although the technique introduced by Plancarte et al is widely practised, the bent needle is sometimes difficult to position precisely and patients find the procedure painful. We modified this approach of block of ganglion impar by positioning the needle into the sacro- coccygeal junction and using the loss of resistance technique. With the patient in the lateral position, a skin wheal was raised at 1-1.5cm below the sacral hiatus. Twenty-three gauge short needle was directly placed into the sacrococcygeal junction with aid of fluoroscopic guidance. From 1 cm behind the anterior margin of the vertebral body in lateral view, we used the loss of resistance technique to confirm the retroperitoneal space. We found this modified approach easier to perform during six blocks for three patients with anorectal or perineal pain. Our modified approach through the sacrococcygeal junction may provide opportunity for wider administration of this procedure because of its simple technique, reduced pain during procedure and decreased risk of infection.