Ultrasonographic-Assisted Ganglion Impar Neurolysis

Abstract

To the Editor: We applaud the description by Gupta et al.1 of ultrasound-assisted block of the ganlion impar. However, because others may wish to perform this block, additional information, including description of the probe and the angle of insonation, should be included. Also, because some subjects will have a substantial concavity of the sacrum-coccyx, which will make accessing the ganglion using a straight needle difficult, regardless of the ancillary imaging technique, the shape and length of the needle and the type of contrast should be provided. I am especially pleased that, almost two decades after our original description with a specific technique,2 the gate remains open and others have endeavored to improve it. Finally, what is most important is that this tiny structure has been acknowledged as having a pivotal role in pain of sympathetic origin in the perineal pelvic region. Before that description, no clinician had suggested it as a target for the management of severe perineal pain.3 Ricardo Plancarte, MD Instituto Nacional de Cancerología Mexico City, D.F. Mexico [email protected] Julio-César González-Ortiz Instituto Nacional de Cancerología Mexico City, Mexico Jorge Guajardo-Rosas Instituto Nacional de Cancerología Mexico City, Mexico Angel Lee Instituto Nacional de la Nutrición Mexico City, Mexico