Choudhary Ranjeet, Kunal Kishor, Kumar Dhirendra, Nagaraju Venishetty, Verma Shilp
Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Raipur, Chhattisgarh, Índia.
Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Jodhpur, Rajasthan, Índia.
Rev Bras Ortop (Sao Paulo). 2021 Oct 28;56(5):558-566. doi: 10.1055/s-0041-1735829. eCollection 2021 Oct.
Nearly 90% of cases of coccydynia can be managed with conservative medical treatment; the remaining 10% need other invasive modalities for pain relief, such as ganglion impar block (GIB) or radiofrequency ablation (RFA) of the ganglion impar. A systematic research was conducted of PubMed, MEDLINE, and Google Scholar to identify studies reporting pain relief in terms of visual analogue scale (VAS), or its counterparts, following GIB or RFA in coccydynia patients with the purpose to determine the efficacy of GIB and RFA of the ganglion impar in controlling pain in coccydynia patients. Seven studies were delineated, with a total of 189 patients (104 in GIB group and 85 in RFA group). In the GIB group, the mean VAS improved from 7.83 at baseline to 3.11 in the short-term follow-up, 3.55 in the intermediate-term follow-up, and 4.71 in the long-term follow-up. In the RFA group, the mean VAS improved from 6.92 at baseline to 4.25 in the short-term follow-up, and 4.04 in the long-term follow-up. In the GIB group, a 13.92% failure rate (11/79) and a 2.88% complication rate (3/104) were reported, while in the RFA group, a 14.08% failure rate (10/71) and no complications (0%) were reported. Total success rate was > 85% with either modality. Ganglion impar block and RFA of the ganglion impar are reliable and probably excellent methods of pain control in coccydynia patients not responding to conservative medical treatment. However, a demarcation between responders, non-responders, and late non-responders should be considered, and larger studies with a longer follow-up (> 1 year) are needed.
近90%的尾骨痛病例可通过保守药物治疗；其余10%需要其他侵入性方法来缓解疼痛，如奇神经节阻滞（GIB）或奇神经节射频消融（RFA）。我们对PubMed、MEDLINE和谷歌学术进行了系统检索，以确定在尾骨痛患者中，报告了GIB或RFA后视觉模拟评分（VAS）或其等效指标疼痛缓解情况的研究，目的是确定奇神经节GIB和RFA在控制尾骨痛患者疼痛方面的疗效。共筛选出7项研究，共有189例患者（GIB组104例，RFA组85例）。在GIB组，平均VAS从基线时的7.83改善至短期随访时的3.11、中期随访时的3.55和长期随访时的4.71。在RFA组，平均VAS从基线时的6.92改善至短期随访时的4.25和长期随访时的4.04。在GIB组，报告的失败率为13.92%（11/79），并发症发生率为2.88%（3/104）；而在RFA组，报告的失败率为14.08%（10/71），并发症发生率为0%（0/85）。两种方法的总成功率均>85%。奇神经节阻滞和奇神经节RFA是治疗对保守药物治疗无反应的尾骨痛患者的可靠且可能极佳的疼痛控制方法。然而，应考虑区分反应者、无反应者和晚期无反应者，并且需要进行随访时间更长（>1年）的更大规模研究。
