Application of ganglion impar block in patient with coccyx dislocation

Abstract

Sacrococcygeal dislocation is a rare injury. The ganglion impar (also called the ganglion of Walther) is a single, small solitary, sympathetic ganglion located in the retrorectal space, anterior to the sacrococcygeal joint or coccyx. It provides the nociceptive and sympathetic supply to the perineal structure. Ganglion impar blockade is not a routinely used anesthetic and analgesic procedure in clinical practice. An elective intrarectal manuel treatment was planned for a woman patient with coccyx dislocation due to falling down from a chair 5 days ago. Ganglion impar block was performed with saccrococcygeal approach using 22 gauge spinal needle along with fluoroscopy following routine monitorization. Blood pressure, heart rate, peripheral oxygen saturation and visual analog scale (VAS) were recorded before and, after block with three minute intervals. VAS value of the patient, 8 before the procedure, decreased 50% 6 minutes after block. Intrarectal manuel treatment was applied to the patient with VAS of 0 at 9th minute. Hemodynamic values were within normal limits during and after the procedure and no motor block was observed. The patient with VAS of 0 at 2nd and 6th hour after block was discharged. VAS of 0 was determined at 24th and 48th hour by phone call. In conclusion, ganglion impar block provided adequate analgesia without causing any complications during and after the intrarectal manuel treatment for the patient with coccyx dislocation. However, we believe that further clinical studies are required to establish the safety and efficiency of this technique for other procedures at perianal region.