Coccygeal Nerve Blockade vs. Impar Ganglion Blockade in Coccydynia: A Randomised Clinical Trial.

Background and objective Coccydynia is a condition that causes pain around the coccyx, severely limiting functionality. Interventional treatment options are available for cases that do not respond to conservative treatment. Coccygeal nerve block (CnB) is a novel method for treating coccydynia. This study compared the efficacy of CnB and ganglion impar block (GiB) and aimed to evaluate the efficacy of CnB in treating coccydynia. Methods  The 12-week results of 56 patients were analysed. One group underwent ultrasound (US)-guided CnB, while the other group underwent fluoroscopy (FL)-guided GiB. Pain intensity was assessed using the numerical rating scale (NRS), and functionality was assessed using the PARIS Coccydynia Functionality Questionnaire. Evaluations were conducted before treatment, as well as four and 12 weeks after treatment. Results The baseline median NRS score was eight in both groups, while at week 12, it was three in the CnB group and 2.5 in the GiB group. The median PARIS score at baseline was seven in the CnB group and 6.5 in the GiB group, while at week 12, it was four and three, respectively. At week 12, compared to baseline, both the CNB and GiB groups showed statistically significant improvements in NRS and PARIS scores (p<0.001). When comparing the two groups, no significant difference was observed in the NRS and PARIS scores before and four and 12 weeks after treatment. No serious adverse events were observed in any patient. Conclusions  Coccydynia is sometimes refractory to treatment. In our study, we found that CnB, a method recently used in the treatment of coccydynia, was as effective as GiB, which has been used for a long time, and we found no evidence of superiority. The lack of radiation exposure due to its US-guided application, the superficial course of the coccygeal nerves and the low depth of needle penetration make it easier to perform. These advantages suggest that it will be a preferable method in the treatment of coccydynia.