Impar ganglion block in patients with pelvic neuropathic pain: Three case Reports and surgical technique

Pelvic pain and coccydynia are discomfort and disabling symptoms for many patients. Assessment and treatment are individualized. Among several options available, the sacrococcygeal ganglion or impar (known as ganglion of Walther), a sensitive station of the pelvis, is one of the main therapeutic targets. Although knowledge about the nature and extent of the innervation pattern of this ganglion in the pelvic region has not been completely elucidated, neuromodulation techniques have been described as efficient treatment options for pelvic pain and coccydynia arising from acute and chronic conditions such as endometriosis, trauma, postsurgical interventions and also from idiopathic factors. The main techniques include chemical rhizotomy with steroids and anesthetics injections or radiofrequency (thermocoagulation). In this review, we report three cases, two with endometriosis and pelvic procedures and one with coccydynia from fracture, who underwent ganglion impar injection. At 6 months follow up, the VAS (Visual Analogue Scale) improvement achieved varied from 70-90%, demonstrating to be a safe, less invasive and efficient technique.