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The most popular method used to block ganglion impar plexus is numbing injections containing local anesthetics, such as lidocaine. Steroid may be added or phenol is used to prolong the pain relief. Some patients undergo radiofrequency ablation therapy soon after the blocking injection to ensure the effect lasts long providing pain relief for months.

Ganglion impar block is done to manage pain originating from

Ganglion impar block is done to manage pain originating from

Tail bone
Urethra
Genital organs, such as pennies, vagina, vulva
Anus
Perineum area between anus and genitals
Rectum
Scrotum

Pain caused by the following conditions is relieved after a ganglion impar block is performed.

Painful cervical, prostate, testicular, colorectal and pelvic organ cancers
Vaginal protrusion leading to pain
Atypical perineal pain
Sacral postherpetic neuralgia
Pelvic pain due to burning heat sensation
Pain preventing sitting
Spinal cord pain (at the tail bone area)
Chronic inflammation of the anus, urethra and rectum
Endometriosis
Severe, episodic, rectal and sacrococcygeal pain
Severe pain while defecating

Ganglion impar is the never center for transmission of pain signals from pelvic, genital and other connected organs to the brain. When a block is performed, the neural structure loses its ability to send pain signals to the brain and remains numbed for longer period. This results in relief from pain until the numbing medication wears out.

Four-time reduction in pain originating in perineal vein, testicles, vaginal protrusion and postherpetic neuralgic pain. (The Clinical Journal of Pain, 2009)
Ganglion impar block relieves pain from perineal hyperhidrosis to a considerable extent. (Korean Journal of Anesthesiology, 2005)
50 percent reduction in chronic perineal pain in eight weeks and continued relief up to four months. (Pain Physician, 2007)
The procedure provides 60 to 90 percent relief from pain associated with cervical cancer, colon cancer and rectal cancer. (Anesthesiology, 1999)
100 percent tail bone pain relief up to one month. (American Journal of Physical Medicine & Rehabilitation, 2005)
At least 74 percent pain relief following ganglion impar block. (Clinical Radiology, 2009)

A patient is considered for ganglion impar block when
there is acute, chronic pain coming from organs or areas innervated by the plexus
there is no relief despite using medication and other therapies for a long period
he or she has no known infection, allergy or condition that may become worse with the injection
he or she has no anesthesia allergy, thrombocytopenia, allodynia, abdominal distension, rectal fistula

Patients lie down on their back and the ganglion impar block procedure is performed using transsacrococcygeal method using a curved needle. Intravenous sedation depends on patient condition. The area above the plexus and deep tissues beneath are numbed using a local anesthesia.

A curved needle is put through the area to reach the ganglion impar plexus. Fluroscopy is used to ensure that the needle follows the expected trajectory and there is no damage to blood vessels or nerves. A dye is injected to confirm the placement of the needle close to the plexus. Now, numbing medication is delivered to the nerve cluster through the needle. Phenol may be injected or radiofrequency ablation is performed to have longer pain relief.

It takes 15 to 30 minutes to perform ganglion impar block.

Injection-site soreness continues for a day after ganglion impar block. There may be an increase in blood sugar level in diabetics. The procedure is performed in an outpatient setting and patients are discharged after a brief observation. Take rest until next morning and use ice packs to overcome injection site soreness. Do not go beyond activities that you can tolerate. Avoid heat and stress on the injection site.

Pain relief is felt within hours of ganglion impar block. It improves in the next 2/3 days and continues until the numbing medication wears thin.

The pain relief continues for a duration that varies depending on patient conditions. On an average pain relief from two to four months is common in patients with ganglion impar block.

Patients may repeat ganglion impar block to have pain relief over much longer period of time. It is up to your doctor to make a decision on the number and time of injections.

Stiffness and soreness at injection site are the most common side effects. Unless performed by experts, ganglion impar block pose serious risks, such as bleeding, nerve damage, injury to surrounding organs, punctured blood vessels and dye spreading into caudal canal.