Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia

Abstract

Context: Focal sympathetic nerve blocks of the ganglion impar are often effective treatments for coccydynia (coccyx pain) and other pelvic pain syndromes. These injections are generally performed under contrast-enhanced fluoroscopic guidance. Vascular uptake may potentially occur during the injection and vascular uptake rates have been reported for other spinal injections, but never for ganglion impar blocks. Aims: The purpose of the study was to determine vascular uptake rates during fluoroscopy-guided ganglion impar blocks. Settings and Design: An academic/University-based Coccyx Pain Center. Methods and Materials: A total of 78 consecutive trans-coccygeal ganglion impar blocks were analyzed for vascular uptake of contrast as determined by intermittent fluoroscopy. Statistical Analysis Used: Direct calculation of incidence. Results: Only one patient (1.3%) demonstrated a vascular uptake pattern, which was readily recognized and corrected by slightly adjusting the position of the needle tip and thereby subsequently obtaining the desired contrast pattern at the ganglion impar. Conclusions: Vascular uptake incidence is low during ganglion impar blocks. This information can be one of the multiple factors considered when a physician is deciding whether or not to use contrast in an individual patient.

Keywords

• coccydynia
• coccyx pain
• ganglion impar
• sympathetic nerve block
• vascular uptake