Ganglion Impar Blockade: a Review

Overview

Journal Curr Pain Headache Rep

Date 2012 Dec 20

PMID 23250792

Citations 16

Authors

Julian Trevor Scott-Warren

Victoria Hill

Anand Rajasekaran

Affiliations

Soon will be listed here.

Abstract

Since its original description in 1990, blockade of the ganglion impar (ganglion of Walther) has become a widely used intervention in the management of pelvic and perineal pain. We review the indications, techniques, and evidence for this pain intervention.

Citing Articles

Ganglion Impar Neurolysis to Treat Refractory Chronic Pain From Vulvar Cancer: A Case Report.

Akinwamide O, Syed A, Mehta J, Andrawis M, Zhang H Cureus. 2024; 16(9):e70128.

PMID: 39463516 PMC: 11502220. DOI: 10.7759/cureus.70128.

Coccygeal Nerve Blockade vs. Impar Ganglion Blockade in Coccydynia: A Randomised Clinical Trial.

Perdecioglu G, Yildiz G Cureus. 2024; 16(9):e69118.

PMID: 39398734 PMC: 11466681. DOI: 10.7759/cureus.69118.

Sympathetic nerve blocks for persistent pain in adults with inoperable abdominopelvic cancer.

Nagar S, Nagar S, Jordan V, Dawson J Cochrane Database Syst Rev. 2024; 6:CD015229.

PMID: 38842054 PMC: 11154857. DOI: 10.1002/14651858.CD015229.pub2.

Rare complication of ganglion impar blockade with the transsacrococcygeal approach: A case of rectal perforation.

Okcu M, Sencan S, Gunduz O Turk J Phys Med Rehabil. 2023; 69(1):121-124.

PMID: 37201018 PMC: 10186016. DOI: 10.5606/tftrd.2022.8874.

Agents Used for Nerve Blocks and Neurolysis.

Wu R, Majdalany B, Lilly M, Prologo J, Kokabi N Semin Intervent Radiol. 2022; 39(4):387-393.

PMID: 36406019 PMC: 9671686. DOI: 10.1055/s-0042-1757315.

References

Hong J, Jang H . Block of the ganglion impar using a coccygeal joint approach. Reg Anesth Pain Med. 2006; 31(6):583-4. DOI: 10.1016/j.rapm.2006.09.001. View

Foye P, Patel S . Paracoccygeal corkscrew approach to ganglion impar injections for tailbone pain. Pain Pract. 2009; 9(4):317-21. DOI: 10.1111/j.1533-2500.2009.00291.x. View

Postacchini F, Massobrio M . Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am. 1983; 65(8):1116-24. View

Wemm Jr K, Saberski L . Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth. 1995; 20(6):544-5. View

Agarwal-Kozlowski K, Lorke D, Habermann C, Am Esch J, Beck H . CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009; 25(7):570-6. DOI: 10.1097/AJP.0b013e3181a5f5c7. View

Oh C, Chung I, Ji H, Yoon D . Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology. 2004; 101(1):249-50. DOI: 10.1097/00000542-200407000-00039. View

Karaman H, Tufek A, Olmez Kavak G, Yildirim Z, Celik F . Would pulsed radiofrequency applied to different anatomical regions have effective results for chronic pain treatment?. J Pak Med Assoc. 2012; 61(9):879-85. View

Nebab E, Florence I . An alternative needle geometry for interruption of the ganglion impar. Anesthesiology. 1997; 86(5):1213-4. DOI: 10.1097/00000542-199705000-00028. View

Toshniwal G, Dureja G, Prashanth S . Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study. Pain Physician. 2007; 10(5):661-6. View

10.

McAllister R . Paramedial approach to the ganglion impar. Reg Anesth Pain Med. 2007; 32(4):367. DOI: 10.1016/j.rapm.2007.05.001. View

11.

Munir M, Zhang J, Ahmad M . A modified needle-inside-needle technique for the ganglion impar block. Can J Anaesth. 2004; 51(9):915-7. DOI: 10.1007/BF03018890. View

12.

Huang J . Another modified approach to the ganglion of Walther block (ganglion of impar). J Clin Anesth. 2003; 15(4):282-3. DOI: 10.1016/s0952-8180(03)00066-7. View

13.

Ho K, Nagi P, Gray L, Huh B . An alternative approach to ganglion impar neurolysis under computed tomography guidance for recurrent vulva cancer. Anesthesiology. 2006; 105(4):861-2. DOI: 10.1097/00000542-200610000-00048. View

14.

Foye P . Ganglion impar injection techniques for coccydynia (coccyx pain) and pelvic pain. Anesthesiology. 2007; 106(5):1062-3. DOI: 10.1097/01.anes.0000265174.90619.80. View

15.

Reig E, Abejon D, Del Pozo C, Insausti J, Contreras R . Thermocoagulation of the ganglion impar or ganglion of Walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Pract. 2006; 5(2):103-10. DOI: 10.1111/j.1533-2500.2005.05206.x. View

16.

Ellinas H, Sethna N . Ganglion impar block for management of chronic coccydynia in an adolescent. Paediatr Anaesth. 2009; 19(11):1137-8. DOI: 10.1111/j.1460-9592.2009.03155.x. View

17.

Foye P . New approaches to ganglion impar blocks via coccygeal joints. Reg Anesth Pain Med. 2007; 32(3):269. DOI: 10.1016/j.rapm.2006.12.005. View

18.

Russo M . Letter to the editor regarding Reig et al., Thermocoagulation of the ganglion impar of Walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Practice 2005;5(2):103-110. Pain Pract. 2006; 5(4):367. DOI: 10.1111/j.1533-2500.2005.00041.x. View

19.

Johnston P, Michalek P . Blockade of the ganglion impar (walther), using ultrasound and a loss of resistance technique. Prague Med Rep. 2012; 113(1):53-7. DOI: 10.14712/23362936.2015.37. View

20.

Sagir O, Ozaslan S, Koroglu A . [Application of ganglion impar block in patient with coccyx dislocation]. Agri. 2011; 23(3):129-33. DOI: 10.5505/agri.2011.86648. View