Ghai Anju, Jangra Priti, Wadhera Sarthak, Kad Nandita, Karwasra R K, Sahu Ankur, Jaiswal Rajmala
Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India.
Department of Postgraduate Student, PGIMS, Rohtak, Haryana, India.
Saudi J Anaesth. 2019 Apr-Jun;13(2):126-130. doi: 10.4103/sja.SJA_667_18.
The blockade of the ganglion impar has been described to relieve the intractable perineal pain of sympathetic origin in patients with coccydynia. Chronic perineal pain (CPP) has been effectively managed by ganglion impar block. The feasibility, safety, and efficacy of ultrasound (US)-guided ganglion impar block by transsacrococcygeal approach was analyzed in the present study.
A total of 15 patients with CPP were administered US-guided ganglion impar block using out of plane approach. Patients were followed for VAS and quality of life using Karnofsky performance status (KS), Linear Analog Scale Assessment (LASA), and constipation score up to 2 months at different time intervals. Time required to perform the procedure, number of attempts, and any complications were also noted.
The mean time required to perform the procedure was 7.67 ± 1.23 min. There were no adverse events. All the patients had significant pain relief during 2 month follow-up ( < 0.05 compared to baseline VAS). The KS and LASA score improved post block which was statistically significant. The dose of nonsteroidal anti-inflammatory drugs (NSAIDS) decreased from preblock state with statistically significant difference, while the difference in dose of tramadol and morphine was statistically insignificant.
US-guided ganglion impar block is technically feasible and safe technique. USG can be used to locate sacrococcygeal junction (SCJ) and facilitate the performance of ganglion impar block. The efficacy and safety of the US-guided ganglion impar blockades needs a proper evaluation in the randomized controlled trials.
已报道阻滞奇神经节可缓解尾骨痛患者源于交感神经的顽固性会阴疼痛。奇神经节阻滞已有效治疗慢性会阴疼痛（CPP）。本研究分析了经骶尾入路超声（US）引导下奇神经节阻滞的可行性、安全性和有效性。
共15例CPP患者采用平面外入路接受US引导下奇神经节阻滞。在不同时间间隔对患者进行随访，采用视觉模拟评分法（VAS）、卡诺夫斯基功能状态量表（KS）、线性模拟评分评估法（LASA）评估生活质量，并记录便秘评分，随访时间长达2个月。记录操作所需时间、穿刺次数及任何并发症。
操作平均所需时间为7.67±1.23分钟。未发生不良事件。所有患者在2个月随访期间疼痛均显著缓解（与基线VAS相比，P<0.05）。阻滞术后KS和LASA评分改善，差异有统计学意义。非甾体抗炎药（NSAIDS）剂量从阻滞前状态降低，差异有统计学意义，而曲马多和吗啡剂量差异无统计学意义。
US引导下奇神经节阻滞是一项技术上可行且安全的技术。超声可用于定位骶尾关节（SCJ）并便于奇神经节阻滞操作。US引导下奇神经节阻滞术的有效性和安全性需要在随机对照试验中进行恰当评估。
