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Procedure: Ganglion Impar Block


What is a ganglion Impar block?

It is an injection of local anesthetic into a group of nerves called the ganglion impar. These nerve cells are located behind the coccyx (tailbone) and can cause chronic pain due to over-activity of the nerve.


What is the purpose of it?

The injection blocks the ganglion impar nerve. This may in turn reduce perineal pain symptoms, especially poorly localized perineal pain stemming from a number of organs including: distal rectum, anus, vulva, distal urethra, and perineum; as well as pain caused by cancer.


How long does the injection take?

The actual injection only takes a few minutes, but plan to be in the office for one to two hours.  This allows for your pre-op and recovery time as well.  Your driver must remain in the building during your procedure.


What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone or methylprednisolone).


Will the injection hurt?

The procedure involves inserting a needle through the skin and deeper tissue (like a tetanus shot). While there is some discomfort involved, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle prior to inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesic, which makes the procedure easy to tolerate.


Will I be “Put Out” for this procedure?

This procedure can be done under local or general sedation.  If the patient does not feel comfortable with just the numbing medication, Coastal Bend Pain Management can give the option of intravenous sedation.  The amount of sedation given generally depends upon the patient’s tolerance.


How is the injection performed?

It is done with the patient lying on their stomach. The patients are monitored with EKG, blood pressure cuff and blood monitoring device. The skin in the tail bone region is cleaned with antiseptic solution and then the injection is carried out.


What should I expect after the injection?

Immediately after the injection, the patient's extremities may feel heavier and possibly numb. Due to the local anesthetic injected during the procedure, patient might notice their pain may be gone or quite less. The patient may also feel sore for two to three days due to the mechanical process of needle insertion as well as initial irritation from the steroid itself.  Patient should start to notice pain relief within three to seven days.


What should I do after the procedure?

The patient should have a driver take them home. Coastal Bend Pain Management advises patients to take it easy for a day or two after the procedure. The patient may perform activities as tolerated by their body. Some patients may go for immediate physical therapy.


Can I go to work the next day?

Unless there are complications, the patient should be able to return to work the next day. The most common thing the patient may feel is soreness at the injection site.


How long does the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of nerves may last for many hours. Usually, the duration of relief gets longer after each injection.


How many injections do I need to have?

If the patient responds to the first injection, they will be recommended for repeat injections, usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.


Will the ganglion impar injection help me?

It is very difficult to predict if the injection(s) will indeed help the patient or not. Patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms. Patients in the advanced stages of disease may not respond adequately.


What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain-which is temporary. The other risks involve bleeding, infection, spinal block, epidural block, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.


Who should not have this injection?

If the patient is allergic to any of the medication being injected, if they are on a blood thinning medication (e.g. Coumadin, Plavix or Aspirin), or if they have an active infection going on near the injection site, they should not have the injection.

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