Improvement in Pain Following Ganglion Impar Blocks and Radiofrequency Ablation in Coccygodynia Patients: A Systematic Review<sup/>

Choudhary, Ranjeet; Kunal, Kishor; Kumar, Dhirendra; Nagaraju, Venishetty; Verma, Shilp

doi:10.1055/s-0041-1735829

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Systematic Review • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1735829 copy

Improvement in Pain Following Ganglion Impar Blocks and Radiofrequency Ablation in Coccygodynia Patients: A Systematic Review^* * Work developed at the All India Institute of Medical Sciences (AIIMS), Raipur, India.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

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

Gonnade et al.	Sencan et al.	Sir and Eksert	Sagir et al
Year	2017	2018	2019	2020
Number	31	28	25	30
Age (mean, in years)	42.9	—	42.64	—
BMI (mean, in kg/m²)	—	29.49	24.73	—
H/o trauma	12	—	—	21
Approach	Sacrococcygeal	Sacrococcygeal	Sacrococcygeal	Sacrococcygeal/transcoccygeal
Scoring system (s) used	NRS, ODI	VAS, LANSS, SF-12	NPRS, LS	VAS
Material	3—5 ml bupivacaine (0.5%) +1 ml methylprednisolone(40 mg)	3 ml bupivacaine (0.5%) +1 ml methylprednisolone(40 mg)	2 ml bupivacaine (0.25%) +1 ml triamcinolone(40 mg)	Bupivacaine (0.25%) +1 ml methylprednisolone(40 mg) totaling 10 ml
VAS-baseline	7.9	7.89	8.0	7.4
VAS-short term	2.03	2.39	3.36	5.5
VAS-intermediateterm	2.48	3.11	4.04	5.2
VAS-long term	3.23	3.89	7.24	5
No improvement	1	7	—	3
Complication	0	2 (minor vasovagalreaction and transientincrease in pain)	1 (bradycardia andhypotension)	0

Demircay et al.	Gopal and McCroy	Adas et al.	Sir and Eksert
Year	2010	2012	2016	2019
Number	10 20 41 14	20	41	14
Age (mean, in years)	49.2	51.3	42.68	42.52
BMI (mean, in kg/m2)	—	—	26.46	27.98
H/o trauma	4	15 trauma	24 trauma	—
Approach	Transcoccygeal (preferred)	Sacrococcygeal	Transcoccygeal	Sacrococcygeal
Scoring system (s) used	VNS	VAS	VAS	NPRS, LS
Method	80 C x 120 second	Pulsed @ 42 C	80 C x 90 second	42 C x 120s x3 cycles
VAS-baseline	8.7	6.82	6.22	7.85
VAS-short term	2.1	3.55	5.37	3.5
VAS-intermediateterm	—	—	—	3.14
VAS-long term	2.9	2.55	5.05	4.05
No improvement	1	5	4	—
Complication	—	0	—	0

Criteria Gonnadeet al.(2017)Adaset al.(2016)Sagiret al.(2020)Demircayet al.(2010)Gopal andMcCroy(2014)Sir andEksert(2020)Sencanet al.(2018)		Gonnadeet al.(2017)	Adaset al.(2016)	Sagiret al.(2020)	Demircayet al.(2010)	Gopal andMcCroy(2014)	Sir andEksert(2020)
1. Was the study question or objective clearly stated?	y	y	y	y	y	y	y
2. Were selection criteria for the study population prespecified and clearly described?	y	y	y	y	y	y	y
3. Were the participants in the study representative of those who would be eligible for the intervention in the general or clinical population of interest?	y	y	y	y	y	y	y
4. Were all eligible participants that met the prespecified entry criteria enrolled?	y	y	y	y	y	y	y
5. Was the sample size sufficiently large to provide confidence in the findings?	N	N	N	N	N	N	N
6. Was the intervention clearly described and delivered consistently across the study population?	Y	Y	Y	Y	Y	Y	Y
7. Were the outcome measures prespecified,clearly defined, valid, reliable, and assessed consistently across all study participants?	Y	Y	Y	Y	Y	Y	Y
8. Were the people assessing the outcomes blinded to the participants’ interventions?	N	CD	CD	CD	CD	CD	N
9. Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?	Y	Y	Y	Y	Y	Y	Y
10. Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p-values for the pre-to-post changes?	Y	Y	Y	Y	N	Y	Y
11. Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?	Y	Y	Y	Y	Y	Y	Y
12. If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.) did the statistical analysis take into account the use of individual-level data todetermine effects at the group level?	NA	NA	NA	NA	NA	NA	NA
	Good	Good	Good	Good	Fair	Good	Good

Primary outcome	Ganglion block	Radiofrequency ablation	Ganglion block (% improvementscore)	Radiofrequency ablation(% improvementscore)	Total	Total(%improvement)
VAS-baseline	7.83	6.92			7.42
VAS-short term(3-4 weeks)	3.11	4.25	60.28	38.58	3.62	51.21
VAS-intermediate term(3 months)	3.55	-	54.66	-	-	-
VAS-long term(6 months)	4.71 4.04 39.85 41.62 4.41 40.57	4.04	39.85	41.62	4.41	40.57
Failure	11	10	-	-	21	-
Complications	3	0	-	-	3	-

PIS	GIB	RFA	Total
Short term	60.28	38.58	51.21
Long term	39.85 41.62 40.57	41.62	40.57

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Kishor Kunal, MS (Orthopaedics), Dept. of Orthopaedics, AIIMS, Jodhpur, PIN 342005, Rajasthan, India (e-mail: drkunal2408@gmail.com)

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Improvement in Pain Following Ganglion Impar Blocks and Radiofrequency Ablation in Coccygodynia Patients: A Systematic Review* * Work developed at the All India Institute of Medical Sciences (AIIMS), Raipur, India.

Abstract

Improvement in Pain Following Ganglion Impar Blocks and Radiofrequency Ablation in Coccygodynia Patients: A Systematic Review^* * Work developed at the All India Institute of Medical Sciences (AIIMS), Raipur, India.