• The Korean Journal of Pain
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• 제10권2호
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• pp.250-253
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• 1997

The perineum is comprised of diverse anatomic structures with mixed sympathetic and somatic innervation. The coccyx is innervated by the coccygeal nerves and branches of the fifth sacral root. Recently, ganglion impar block has been introduced as an alternative means of managing intractable pain of sympathetic origin, coccygodynia by trauma, tenesmus and perineal hyperhydrosis. We managed a 59-year-old female patient who had suffered from perineal pain by metastasis of cervical cancer. Approach to impar ganglion through the anococcygeal ligament was impossible because her coccyx was hyperflexed anteriorly by old fracture. But we could perform ganglion impar block successfully by approach through the separation of sacrum and coccyx.

• The Korean Journal of Pain
• /
• 제10권2호
• /
• pp.254-257
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• 1997

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 at 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 sacrococcygeal 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.