• Ganglion Impar Block

    1. What is a ganglion impar block?

    A ganglion impar block is a procedure used to reduce some of the symptoms of chronic pelvic or rectal pain by blocking nerve impulses. The ganglion impar is a structure located at the level of the coccyx.

    The nerve block can be diagnostic or therapeutic. One of three things will happen: 

    1. The pain does not go away, which means that it is probably not coming from the nerves at the site of the injection. This is of diagnostic value.
    2. The pain goes away and stays away for a few hours, but then returns. In this case, the block is also of diagnostic value, as it means the pain is probably coming from the nerves at the level of the injection, but the steroid was of no benefit.
    3. The pain goes away after the block but returns later that day and then improves over the next few days. This means that the block was of therapeutic value, as both the anesthetic agent and the steroid had an effect on the pain.

    If you experience some benefit from the injection, it may be repeated.

    Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.

    2. What are the risks of the procedure?

    As with most procedures, there is a remote risk of bleeding, infection, nerve injury or an allergic reaction to the medications used. Some short-term side effects may occur, as well. The injection of local anesthetic onto the nerve may cause some numbness that follows the path of the nerve that was blocked. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have a short-term elevation of blood sugars from the steroid. 

    3. What happens during the procedure?

    After checking in, you will sign a consent form, have your vital signs taken and be asked several procedure-related questions. Please wear loose-fitting clothing. Sometimes you may be asked to change into a hospital gown.

    Once in the procedure room, our nursing staff will position you on your stomach on a narrow table. Your back will be cleaned with iodine and sterilely draped. The doctor will numb your skin with a small needle, which will sting just a bit. It is very important to hold still and let us know if we are causing you discomfort. Next, the doctor will use an X-ray machine (fluoroscope) to guide the needle into the correct spot. An X-ray contrast (dye) may be injected at this point to confirm that the needle has been positioned correctly. Please let the doctor know if you have an allergy to dye. Local anesthetic and steroid are then injected through the needle, and the needle is removed. Your skin will be cleaned and a Band-Aid may be applied. The Band-Aid may be removed the next morning. The procedure should take 10 to 15 minutes.

    Your pain may improve immediately after the injection due to the local anesthetic. It is important to keep track of how you feel for the remainder of the day. The steroid usually takes two or three days to have an effect in most people and peaks in about two weeks. It is important that you keep track of the amount of pain relief you receive and how long it lasts, as you will be calling the office to report your results.

    4. What happens after the procedure?

    After the procedure, you will go to the ambulatory recovery area. You will remain there for 5 to 15 minutes before being discharged home. You may have some local tenderness from the needles, which ice may help relieve. You may also resume all of your medications, including those you take for pain.

    5. Will I have any restrictions after the procedure?

    Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub, pool or Jacuzzi on the day of your procedure. Otherwise, you may resume your other normal activities.

    6. For what reasons should I call the Pain Management Center after the injection?

    You should call us immediately at 781-744-5090 if you experience any of the following: 

    • Severe back pain that is not relieved with medication and ice
    • Prolonged, new numbness or weakness of your legs
    • Loss of control of your bladder or bowels
    • Signs of infection in the area of injection

    Things to Do Before the Procedure

    • Any dietary restrictions will be discussed on the day the procedure is booked.
    • Take all of your medications as scheduled on the day of the procedure, unless directed otherwise.
    • Think of any questions for us and write them down.
    • Make the nurses and doctors aware of any new changes in your medical condition.
    • Before you come in, let us know if you are taking any blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal) or anti-inflammatories.
    • Please remember to arrange for an adult to drive you home.
  • Make an Appointment

    (781) 744-5090