Ganglion Impar Research Articles

Conventional versus high-voltage, long-term pulse Radiofrequency of ganglion impar in perineal pain with advanced rectal cancer: a Randomized, double-blind controlled trial

Study objectiveAdvanced rectal cancer is a common cause of perineal pain and research on the use of radiofrequency therapy for the treatment of this pain is limited. In the present study, we aimed to compare the effectiveness and safety of conventional radiofrequency (CRF) and high-voltage long-term pulsed radiofrequency (H-PRF) of radiofrequency therapy in the management of perineal pain in advanced rectal cancer.DesignRandomized, Double-Blind Controlled Trial.SettingSichuan Cancer Hospital & Institute and Yanjiang District People’s Hospital in Sichuan, China.ParticipantsA total of 72 patients with advanced rectal cancer experiencing perineal pain who were accepted for radiofrequency treatment.InterventionsPatients were assigned randomly (1:1) assigned to either the group CRF or H-PRF in a double-blind trial.Measurements and main resultsThe primary focus was on assessing perineal pain using numeric rating scales (NRS) scores at various time points. Secondary outcomes included the duration of maintaining a sitting position, depression scores, sleep quality, consumption of Oral Morphine Equivalent and Pregabalin, and the incidence of perineal numbness. A total of 57 patients (28 patients in the group CRF and 29 patients in the group H-PRF) were investigated. At all observation time points postoperatively, both groups of patients exhibited significant reductions in pain, enhancements in depression, improvements in sleep quality, and increased duration of sitting compared to their baseline measurements (P<0.05). During the 3 months and 6 months follow-up period, the group CRF exhibited significant reduction in pain, improvement in depression, sleep quality, and increased the time of keeping a sitting position compared with the group H-PRF (P<0.05). The consumption of oral morphine equivalent and Pregabalin as well as the incidence of perineal numbness were not significantly different between groups (P > 0.05).ConclusionOur results demonstrate that application of CRF and H-PRF in ganglion impar to reduce perineal pain and improve the quality of life of patients with advanced rectal cancer is safe and effective. However, the long-term effect of CRF is better compared with that of H-PRF.Trial registrationhttps://www.chictr.org.cn/ (ChiCTR2200061800) on 02/07/2022. This study adheres to CONSORT guidelines.

Pain Management with Ganglion Impar Block in Adenocarcinoma Recti

&lt;strong&gt;Background:&lt;/strong&gt;Colorectal cancer is a type of malignant neoplasm that is often found with the third highest mortality rate in the world after breast cancer and lung cancer. Adenocarcinoma is the most common type of colorectal cancer which cause pain to the patient. The pain from this disease was described as chronic pain. Chronic pain can result from ongoing nerve inflammation and central sensitization. Inflammation begins with a mechanical injury which then turns into chronic inflammation. This situation changes the responsiveness of neurons to pain in the sympathetic ganglion. Sympathetic ganglia block is more effective in controlling visceral pain. This impar ganglion is the only sympathetic nervous system ganglion that is not attached to the sacrococcygeal. In this case report, the transsacrococcygeal joint approach was used to locate the ganglion accurately by injecting contrast and viewing the vertical dispersion called inverted commas along the ganglion laterally.&lt;p&gt;&lt;strong&gt;Case Illustration:&lt;/strong&gt; A 60-year-old female patient was admitted with complaints of pain around the anus. The patient has been diagnosed with Adenocarcinoma recti two years ago. Pain is felt like being stabbed and persists in the anal area. Pain intensity increases on sitting and defecation. The patient has undergone chemotherapy 12 times and is taking pain relievers that have been prescribed regularly. The patient's Numeric Rating Scale (NRS) score is 6-7, which is categorized as severe pain. This patient underwent ganglion impar block using the trans sacrococcygeal joint approach with the help of fluoroscopy to relieve the severe pain.&lt;/p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Ganglion Impar Block (GIB) can be performed with significant results in reducing opioid use and reducing pain in patients with Adenocarcinoma recti. The technique of administering neurolysis agents with the help of fluoroscopy can be an option because it is very effective and simple

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Chronic pelvic pain (CPP) is usually treated conservatively, but in patients who do not respond to treatment, ganglion impar (GI) interventions are used as an alternative way to reduce pain. Objective ‒ to study the course of pain syndrome and functional status in patients with coccygodynia (CD) and CPP during the application of minimally invasive interventions on GI. Materials and methods. The analysis of the results of 56 interventions on GI in 50 patients was performed. Inclusion criteria were patients with coccyx pain for ≥3 months aged 23 to 71 years (mean age 47.9±14.8years) who did not respond to conservative treatment methods. 15 (35.7%) of the study participants were male and 27 (64.3%) were female. Interventions were performed on the patients according to five different methods, which were divided into two groups: the first group (n=34) ‒ GI block (GIB) with a local anesthetic and a steroid (patients with CD in whom medical conservative methods of treatment were not effective). The second group (n=14) consisted of persons with recurrent pain syndrome, resistant forms of CD and CPP, including after previously performed steroid injections: n=2 – neurolysis of GI with ethyl alcohol; n=2 – neurolysis of GI by phenol; n=3 – radio frequency modulation of GI; n=7 – radiofrequency ablation of GI. Results. 14.0% of all study participants had post-traumatic CD (history of falling on the coccyx), the vast majority of 86.0% ‒ idiopathic CD. Pain intensity was significantly lower post-intervention compared to baseline VAS mean of 7.6±1.5 cm: 2.5±0.9 cm one-week post-procedure, 1.5±1.9 cm one month, 1.3±1.5 cm three months, 2.1±1.2 cm six months. The average score according to the Karnovsky Scale (KS) before and after the procedure was 73.3±6.3% and 83.9±4.9%, respectively. Conclusions. Interventions on ganglion impar are an effective method of treating patients with coccygodynia of various etiology, which significantly reduce pain according to the VAS scale (p&lt;0.001) and improve the quality of life according to the KS (p&lt;0.001) in dynamics after 1, 3, 6 months. Minimally invasive interventions on ganglion impar make it possible to reduce tissue trauma, to quickly recover for patients after the procedure, and to minimize any complications. In the first and second groups of the study, there was a decrease in the pain on the VAS from 8.0 cm to 2.0 cm (p&lt;0.0001) and from 7.0 cm to 2,7 cm (p&lt;0.001) before and after the procedure, respectively. In the first and second groups of the study, there was an improvement in the indicator of functional status according to the KS from 70% (95% сonfidence interval (CI) 60‒90%) to 90% (95% CI 70‒100%, p&lt;0.0001) and from 70% (95% CI 70‒90%) to 90% (95% CI 80‒100%, p=0.001) before and after the procedure, respectively.

Assessment of Ganglion Impar Block Effect on Treatment Results of Coccydynia: A Cross-Sectional Study.

The ganglion impar block is a minimally invasive technique used for alleviating pain associated with coccydynia. This research evaluates the effectiveness of the ganglion impar block in treating patients with coccydynia who have not benefited from conservative treatments. This cross-sectional analysis reviewed the clinical records of coccydynia patients who received ganglion impar block injections at Urmia Imam Khomeini Hospital, Urmia, Iran, between 2020 and 2022. Data regarding age, gender, body mass index (BMI), onset of pain, and levels of patient satisfaction post-treatment were gathered from the medical records. The study comprised 26 patients, with 4 (15.4%) being male and 22 (84.6%) female. The average age and BMI were 39.15 ± 14.24 years and 28.91 ± 2.14 kg/m2, respectively, which did not show significant variation (P = 0.19). The average Visual Analogue Scale (VAS) score before the ganglion impar block was 6.23 ± 2.35, which reduced to 4.47 ± 2.41 immediately after the procedure. At the 1-month follow-up, the average VAS score had further decreased to 3.47 ± 0.79. The decrease in VAS scores, both immediately after the procedure and at the 1-month follow-up, was statistically significant. The success rate of the block (defined as a reduction in pain of at least 20% from the baseline) was significantly high immediately and one-month post-procedure (P < 0.001). Out of the 26 patients treated with the impar block, satisfaction rates were 42.3% excellent, 27% good, 19.2% fair, and 11.5% poor. The study endorses the trans-sacro-coccygeal "needle inside needle" method for providing relief to patients suffering from coccydynia. The findings revealed significant patient satisfaction, with the majority describing their experience as excellent.

REFRACTORY VULVODYNEA AND THE PROMISING RESULTS WITH ODD GANGLION BLOCKAGE

Vulvodynia is a chronic gynecological disease with no clear cause, lasting at least three months, presenting a history of intense pain with a neuropathic component, starting before diagnosis, refractory treatment with steroids, hormonal therapy, anticonvulsants, antidepressants, psychotherapy, physiotherapy , acupuncture and even vulvectomy. The odd ganglion is the most caudal of the sympathetic ganglion chain. Visceral afferent fibers originating from the perineum, distal rectum, anus, distal section of the urethra, vulva, and vagina are found in the distal third of this ganglion. Its blockade has been effectively used to control pain in patients with vulvodynia. Women with chronic gynecological diseases who received multimodal pain therapy and underwent infiltration with local anesthetics in the impar ganglion demonstrated successful therapy in the majority of them. Blockade is a good treatment option for patients suffering from chronic pain and discomfort caused by vulvodynia.

Radiation-Induced Coccydynia and Pelvic Pain From Insufficiency Fracture Treated With Ganglion Impar Block

BACKGROUND: Pelvic insufficiency fractures can be a delayed effect from radiation therapy. As a result, significant pain, debility, and reduction in quality of life can occur. We describes the utility of ganglion impar blockade in the treatment of coccydynia and pelvic pain related to insufficiency fracture. CASE REPORT: The patient is a 71-year-old woman with stage 2 grade II endometrial cancer that presented with pelvic and tailbone pain approximately 4 years after completing radiation therapy and was found to have a sacral insufficiency fracture. She underwent ganglion impar blockade on 2 occasions with marked improvement in her pain and functionality after each injection. CONCLUSIONS: Fluoroscopic-guided ganglion impar block may be a safe and useful intervention to reduce pain in cancer patients with pelvic and/or tailbone pain related to insufficiency fracture KEY WORDS: Cancer pain, pelvic pain, tailbone pain, insufficiency fracture, ganglion impar block

The Influence of Coccygeal Dynamic Patterns in Ganglion Impar Block for the Treatment of Chronic Refractory Coccydynia.

Patients with persistent coccygodynia who do not respond to conventional therapies may undergo ganglion impar block (GIB). We looked at how GIB therapy for individuals with persistent coccygodynia affected their coccygeal dynamic patterns. Patients with persistent coccydynia with GIB once using a trans-Sacro-coccygeal technique with fluoroscopy supervision were taken up for the study. Out of 14 patients, they were categorized as Group I- mobile coccyx (8 patients) and Group 2- immobile coccyx (6 patients) using static and dynamic coccyx radiographs, based on coccygeal mobility. A visual analog score (VAS) was used to measure pain levels both before and after the intervention (at 1 hour and 2, 4 weeks). A VAS score drop of 50% or more was considered to be a meaningful reduction in pain. On every subsequent visit, the VAS scores were considerably lower in both groups, the pre- and post-intervention VAS scores significantly differed between the two groups. In follow-up, there was no significant difference in the scores between the two groups. Normal and immobile coccyges detected by standard and dynamic radiographs of patients with chronic coccydynia appear to be two different coccygeal dynamic patterns that do not affect the treatment outcome in Ganglion Impar Block.

Evaluation of the Results of Ganglion Impar Blockade in Patients with Chronic Coccydynia

Evaluation of the Results of Ganglion Impar Blockade in Patients with Chronic Coccydynia

The Role of Interventional Pain Management Strategies for Neuropathic Pelvic Pain in Endometriosis

BACKGROUND: Endometriosis is a chronic common condition affecting 10% of reproductive-aged women globally. It is caused by the growth of endometrial-like tissue outside the uterine cavity and leads to chronic pelvic pain, affecting various aspects of a woman’s physical, mental, emotional, and social well-being. This highlights the importance of an understanding of the potential involvement of the nervous system and involved nerves as well as an effective multidisciplinary pain management. OBJECTIVES: Our aim was to assess the current understanding of pain mechanisms in endometriosis and the effectiveness of different interventional pain management strategies. STUDY DESIGN: Literature review. METHODS: A search was conducted using multiple databases, including Google Scholar, MEDLINE (Ovid), PubMed, and Embase. We used keywords such as “endometriosis,” “pain,” pelvic pain, “management,” and “anaesthesia” along with Boolean operators and MeSH terms. The search was limited to English language articles published in the last 15 years. RESULTS: Nerve involvement is a well-established mechanism for pain generation in patients with endometriosis, through direct invasion, irritation, neuroangiogenesis, peripheral and central sensitization, and scar tissue formation. Endometriosis may also affect nerve fibers in the pelvic region, causing chronic pelvic pain, including sciatic neuropathy and compression of other pelvic nerves. Endometriosis can cause sciatica, often misdiagnosed due to atypical symptoms. Interventional pain management techniques such as superior hypogastric plexus block, impar ganglion block, S3 pulsed radiofrequency, myofascial pain trigger point release, peripheral nerve hydrodissection, and neuromodulation have been used to manage persistent and intractable pain with positive patient outcomes and improved quality of life. LIMITATIONS: The complex and diverse clinical presentations of endometriosis make it challenging to compare the effectiveness of different pain management techniques. CONCLUSION: Endometriosis is a complex condition causing various forms of pain including nerve involvement, scar tissue formation, and bowel/bladder symptoms. Interventional pain management techniques are effective for managing endometriosis-related pain. KEY WORDS: Endometriosis, chronic pain, therapeutic interventions, interventional techniques, pain injections, visceral pain, peripheral pain

Coccydynia: anatomic origin and considerations regarding the effectiveness of injections for pain management.

Coccydynia is a debilitating pain disorder. However, its pathophysiology is not well understood. When approaching coccydynia, the exact underlying cause of pain must be identified to develop an appropriate treatment plan. The specific approach to coccydynia can vary depending on an individual's condition and the underlying cause. Thorough evaluation by a pain physician is essential to determine the most appropriate course of treatment. The purpose of this review is to examine the various causes contributing to coccygeal pain and specifically focus on the exact anatomical neurostructures, such as the anococcygeal nerve, perforating cutaneous nerve, and ganglion impar. We also reviewed the relevant clinical outcomes and suggested recommendations for each anatomical structure.

Ganglion Impar Block For Chronic Coccydynia.

Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life. A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months' coccygeal pain of either gender aged between 20-60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods. The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38-60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001). Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.

Ultrasound-guided Ganglion Impar Block during the COVID-19 Pandemic: Two Case Reports

Blocks of the ganglion impar are used to treat both malignant and benign causes of visceral and sympathetic pelvic and perineal pain. While conventionally done under fluoroscopic guidance, significant improvements in transducer technology in the past decade have piqued the interest and enthusiasm of interventional pain specialists toward ultrasound-guided performance. In the setting of a pandemic, it is important to ensure the efficacy of treatment as well as the safety of both patients and health care workers. This paper presents two patients who underwent two approaches of ultrasound-guided ganglion impar blocks in a tertiary government hospital in the Philippines during the COVID-19 pandemic.

S1082 Endoscopic Ultrasound-Guided Superior Hypogastric Plexus Neurolysis: An Update on a Unique Technique for the Management of Pelvic Pain

Introduction: The superior hypogastric plexus is a paired structure located anterior to the sacral promontory, in close proximity to the bifurcation of common iliac vessels. It mediates painful visceral stimuli from most of the pelvic structures. Superior hypogastric plexus neurolysis (SHPN) is a well-recognized treatment for pelvic pain resulting from cancer of sigmoid colon, rectum, prostate, bladder, cervix, and uterus. It is also used to manage pain resulting from benign conditions such as endometriosis, pelvic inflammatory disease, and radiation colitis. The conventional approach used by pain experts is difficult and requires CT guidance. The purpose of this study was to test the hypothesis that endoscopic ultrasound (EUS)-guided SHPN is technically feasible. Methods: Patients with severe pelvic pain due to cancer were eligible for the study. Consecutive patients with pelvic pain secondary to cancer were offered to participate in the study. Pain was graded before and after the procedure and weekly thereafter, by using a visual analog scale graded from 1 to 10. A linear scope was introduced into the rectum and advanced until iliac vessels were identified. In 10 patients, the sacral promontory was identified with fluoroscopy. A 22-gauge needle was passed in the space posterior to the rectum and 10 mL of bupivacaine injected, followed by 10 mL absolute alcohol. In one patient, internal iliac vessels were identified by using EUS and the injections were given anterior to the periosteum; fluoroscopy was not used. Results: SHPN was performed in 11 patients with pelvic pain due to cancer. The procedure was completed successfully in all patients. The mean pain score was 9 before the procedure and 3 after (Table). No complications were encountered. The mean procedure time was 20 minutes. Conclusion: Our study reveals that EUS-guided SHPN is technically feasible. The iliac vessels are well seen by this approach, thus making hemorrhage an unlikely complication. Table 1. - Patient's Clinical profile and Pre-Visual analogue scale and Post-Visual analogue scale scores Number Diagnosis Pre-VAS Post-VAS Duration of Relief (weeks) 1 Rectal Cancer 10 3 6 2 Rectal Cancer 9 2 14 3 Rectal Cancer 8 3 12 4 Prostate Cancer 9 4 6 5 Rectal Cancer 10 2 12 6 Cervix Cancer 9 3 16 7 Sigmoid Cancer 9 5 8 8 Uterine Cancer 8 3 10 9 Rectal Cancer 9 4 24 10 Rectal Cancer 10 2 18 11 Anal Cancer* 10 3 16 *Superior Hypogastric and Ganglion Impar Neurolysis.VAS = Visual analogue scale.

Comparison of Visual Analog Scale (VAS) between Pulsed and Thermal Radiofrequency Ablation of Ganglion Impar in Patients of Chronic Pelvic Pain

The present study was done to compare theVisual Analog Scale (VAS) score between Thermal and Pulsed radiofrequency ablation in Ganglion Impar block for treatment of chronic pelvic pain in female patients. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain, having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean Pre-procedural VAS score of the patients in Group A was 7.93 ± 0.704 where as mean Pre-procedure VAS score in patients of group B was 8.00 ± 0.655.( P =0.790).Mean 24 Hours Post Procedural VAS Score of the patients in Group A was 2.53 ± 0.516 where as mean 24 Hours Post Procedural VAS Score in patients of group B was 3.53 ± 0.640.( P= 0.000). Mean 1 week Post Procedural VAS Score of the patients in Group A was 2.60 ± 0.507 where as mean 1 week Post Procedural VAS Score in patients of group B was 3.40 ± 0.507. (P= 0.000) Mean 2 week Post Procedural VAS Score of the patients in Group A was 2.33 ± 0.507 where as mean 2 week Post Procedural VAS Score in patients of group B was 3.31 ± 0.564. (P=0.000) .Mean 3 week Post Procedural VAS Score of the patients in Group A was 2.31 ± 0.415 where as mean 3 week Post Procedural VAS Score in patients of group B was 3.29 ± 0.516.( P =0.000). Conclusion: Present study showed that mean Post Procedural VAS Score(24 Hours, 1,2 and 3 week) was significantly lower in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces prolonged pain free period in the patients as compared to patients who were treated with pulsed radio frequency ablation.

Comparison of Post Procedural Medication Requirement and Side Effects among the Patients of Chronic Pelvic Pain in Pulsed Radiofrequency Ablation versus Thermal Radiofrequency Ablation of Ganglion Impar

The present study was done to compare the Post Procedural medication requirement and side effects among the patients of chronic pelvic pain in pulsed radiofrequency ablation versus thermal radiofrequency ablation of Ganglion Impar. Material andMethods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain , having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean age (in years) in group A and B was found to be 47.60± 6.833 and 42.67±7.807 years respectively. The p value was calculated to be 0.76 which was found to be statistically non significant. In Group A, 13(86.7%) patients didn’t need any Medication to be started Post Procedure and 2(13.3 %) need medication post procedural while in Group B, 6(40.0%) patients didn’t need any Medication to be started Post Procedure and 9(60.0 %) need medication post procedural. The P value was 0.021 which was statistically significant. In both Group A and B None of the patients had any side effects post procedural. Conclusion: Present study showed that Post Procedural medication requirement was significantly less in group A as compared to group B and none of the patients had any side effects post procedural in both Groups.

Comparison of Quality of life in patients of chronic pelvic pain after pulsed radiofrequency ablation versus thermal radiofrequency ablation of Ganglion Impar

Background: The present study was done to compare the Quality of life in patients of chronic pelvic pain after pulsed radiofrequency ablation versus thermal radiofrequency ablation of Ganglion Impar. Material andMethods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain , having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean 24 Hours Post Procedural American Chronic Pain Association Quality Of Life Scale Score(ACP) of the patients in Group A was 6.20 ± 0.414 where as mean 24 Hours Post Procedural ACP Score in patients of group B was 7.07 ± 0.704.(P=0.000). The mean 1 week Post Procedural ACP Score of the patients in Group A was 6.00 ± 0.000 where as mean 1 week Post Procedural ACP Score in patients of group B was 6.73 ± 0.704.( P=0.000). Mean 2 week Post Procedural ACP Score of the patients in Group A was 5.53 ± 0.516 where as mean 2 week Post Procedural ACP Score in patients of group B was 6.47 ± 0.743.(P =0.000). Mean 3 week Post Procedural ACP Score of the patients in Group A was 5.20 ± 0.414 where as mean 3 week Post Procedural ACP Score in patients of group B was 6.27 ± 0.458.(P=0.000). Conclusion: Present study showed that mean Post Procedural ACP Score (24 Hours, 1,2and 3 week) was significantly lower in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces Quality of Lifeand Functional Capacity in the patients as compared to patients who were treated with pulsed radio frequency ablation.

Comparison of Satisfaction Level Using Likert Scale among Patients of Chronic Pelvic Pain in Pulsed Radiofrequency Ablation versus Thermal Radiofrequency Ablation of Ganglion Impar

The present study was done to compare the Satisfaction level using Likert Scale among patients of chronic pelvic pain in pulsed radiofrequency ablation versus thermal radiofrequency ablation of Ganglion Impar. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain , having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean age (in years) in group A and B was found to be 47.60± 6.833 and 42.67±7.807 years respectively. The p value was calculated to be 0.76 which was found to be statistically non significant. According to Post 24 Hours Likert scale, in Group A, 2(13.3%) patients were satisfied and 13(86.7%) were very satisfied while in Group B, 1(6.7%) patient was neutral , 10(66.7%) were satisfied and 4(26.7%) patients were very satisfied. (P= 0.004). According to Post 1 week Likert scale, in Group A, 2(13.3%) patients were satisfied and 13(86.7%) were very satisfied while in Group B, 1(6.7%) patient was neutral , 9(60.0%) were satisfied and 5(33.3%) patients were very satisfied.(p=0.011) Similarly 100% of the patients of group A were satisfied with the procedure as compared to patients of group B 3 weeks after the procedure.( p =0.011). Conclusion: Present study showed that mean Post Procedural satisfaction level using Likert Scale (24 Hours, 1,2 AND 3 week) was significantly more in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces better satisfaction level in the patients as compared to patients who were treated with pulsed radio frequency ablation.

Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain

Evaluation of Impar Ganglion Block Effectivity in the Management of Chronic Perineal Pain

Minimally-invasive pain management techniques in palliative care.

Pain is a common source of suffering for seriously ill patients. Typical first-line treatments consist of lifestyle modifications and medication therapy, including opioids. However, medical treatments often fail or are associated with limiting systemic toxicities, and more targeted interventional approaches are necessary. Herein, we present options for minimally invasive techniques for the alleviation of pain in palliative patients from a head-to-toe approach, with a focus on emerging therapies and advanced techniques. Head and neck: image-guided interventions targeted to sympathetic ganglia of the head and neck, such as sphenopalatine ganglion (SPG) and stellate ganglion, have been shown to be effective for some forms of sympathetically-maintained and visceral pain. Interventions targeting branches of cranial nerves and upper cervical nerves, such as the glossopharyngeal nerve (GPN), are options in treating somatic head and face pain. Abdominal and pelvic: sympathetic blocks, including celiac plexus, inferior hypogastric, and ganglion impar can relieve visceral abdominal and pelvic pain. Spine and somatic pain: fascial plane blocks of the chest and abdominal wall and myofascial trigger point injections can be used for somatic pain indications. Cementoplasties, such as kyphoplasty and vertebroplasty, are used for pain related to bony metastases and compression fractures. Tumor ablative techniques can also be used for lytic lesions of the bone. Spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cordotomy have also been used successfully in patients requiring advanced options, such as those with significant spinal, ischemic, or visceral pain.

Lower EUS-guided ganglion impar blockade.

Video 1.