Ganglion of impar block

What is it:

The ganglion impar is a solitary retroperitoneal structure located at the level of the sacrococcygeal junction. This unpaired ganglion marks the end of the two sympathetic chains. Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the ganglion impar . Patients who will benefit from this block frequently present with a vague, poorly localized pain that is frequently accompanied by sensations of burning and urgency. However, the clinical value of this block is not clear as the published experienced is limited.

How is it Done:

This block may be performed with the patient in the left lateral decubitus position with the knees flexed, in the lithotomy position, or in the prone position. The easiest approach is with the patient in theprone position, where a 20-g 1.5-inch needle is inserted through the sacrococcygeal ligament in the midline.The needle is then advanced until the tip is placed posterior to the rectum.
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