A modified needle-inside-needle technique for the ganglion impar block

Area of Science:

• Pain Medicine
• Interventional Radiology
• Anesthesiology

Background:

• The ganglion impar, located at the sacrococcygeal junction, is a target for pain management.
• Previous approaches include bent/curved needles via the anococcygeal ligament and straight needles via the sacrococcygeal disc.

Purpose of the Study:

• To describe a novel needle-inside-needle modification for accessing the ganglion impar via the sacrococcygeal disc.

Main Methods:

• A 22-gauge needle was inserted through the sacrococcygeal ligament under fluoroscopy.
• A 25-gauge needle was then introduced through the 22-gauge needle.
• Placement was confirmed using contrast injection (iopamidol 300) and the 'comma sign'.

Main Results:

• The needle-inside-needle technique aims to mitigate risks associated with other approaches.
• Potential benefits include reduced discomfort, tissue trauma, and risk of rectal perforation compared to bent/curved needles.
• It may also reduce risks of discitis and needle breakage associated with longer straight needles.

Conclusions:

• The needle-inside-needle technique offers a promising modification for ganglion impar blockade.
• This technique may improve safety and efficacy in managing sacrococcygeal pain.
• Further studies may be warranted to validate its clinical utility.