Safe ganglion Impar blocks for visceral and coccyx pain

Techniques in Regional Anesthesia and Pain Management

2008 April; 12 (2): 122-123

Patrick M. Foye, MD

Director, Coccyx Pain Service, Department of Physical Medicine and Rehabilitation, UMDNJ: New Jersey Medical School, 90 Bergen St., DOC-3100, Newark, NJ 07103-2499. Phone: (973)972-2802. Fax: (973)972-2825.


In this publication, Dr. Foye outlines the technical differences between various approaches used in performing ganglion Impar sympathetic nerve blocks in the treatment of coccyx pain and other pelvic pain syndromes. The ganglion Impar is located just in front of the tailbone, where it functions as a network or hub of nerve fibers, as part of the synthetic nervous system. This publication incorporates recent information regarding the precise location of the ganglion Impar and discusses how this relates to the optimal approaches used by the physician performing an injection to block this nerve hub.

Five different approaches (five different pathways of the needle being inserted) are reviewed. These include older approaches using longer needles inserted just above the anus (e.g., the bent needle technique first described by Plancarte and the curved needle technique of Nebab), as well as needle insertion through the sacrococcygeal joint (first described by Wemm) and the more recent techniques of inserting the needle through joint spaces in between the coccygeal bones (first described by Foye).

The publication discusses some of the technical aspects that physicians should be aware of when deciding which approach to use when performing this injection in patients.

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