Infiltration of impar and caudal ganglia in the management of traumatic coccydynia refractory to conventional analgesic treatment

Revista Española de Cirugía Ortopédica y Traumatología

2011; 55(5): 340-345

M. Cortiñas Sáenz (a), J.A. Iglesias Cerrillo (a), C. Vázquez Colomo (b), G. Salmerón Vélez (b), A. Quirante Pizarro (a), F. Jerez Collado (c).

(a) Anestesiología, Unidad de Dolor, Hospital Torrecárdenas de Almería, Almería, Spain

(b) Traumatología y Ortopedia, Hospital Torrecárdenas de Almería, Almería, Spain

(c) Unidad de Dolor, Hospital Torrecárdenas de Almería, Almería, Spain

Abstract

Introduction:

Coccydynia is a term that refers to pain in the region of the coccyx. Most cases are associated with abnormal mobility of the coccyx which may trigger a chronic inflammatory process leading to degeneration of this structure. Non-surgical management remains the gold standard treatment for coccydynia, consisting of decreased sitting, seat cushioning, coccygeal massage, stretching, manipulation, local injection of steroids or anaesthetics, and postural adjustments.

Materials and methods:

A retrospective study of 23 patients who underwent treatment for coccydynia and failed to respond to conservative management. They were treated by radiologically guided infiltration of the ganglion blockade impar and/or caudal blockade with 1% lidocaine 60-80 mg triamcinolone. Of these 23 patients, 21 were available for clinical review and completed a questionnaire giving their assessment of the effect of the infiltration of the ganglion impar block and/or caudal block.

Results:

Good results were obtained in 16 of the 21 patients with coccydynia due to trauma. In five patients the results were moderate or poor, although none described worse pain after the operation. They are no complications after the infiltration.

Conclusion:

Ganglion impar block and/or caudal block offered satisfactory relief of pain in the majority of patients regardless of the cause of their symptoms.


Note from Jon Miles:

Despite the positive conclusion of this paper, Figure 3 below shows that the average pain score (VAS) after six months was nearly as high as it was before treatment. This is consistent with the personal experiences of people on this website, that the pain relief from injections typically lasts 3-6 months.

figure 3, Variation in the VAS pain score following blocking of the caudal and the ganglion impar.

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