17 Ultrasound guided associated to the fluoroscopy could improve the efficacy and safety of the radiofrequency application on the ganglion impar: a case report

Background and Aims Chronic perineal pains is a painful condition. In this study, we aimed to assess the effect the ultrasound associated to the fluoroscopy for improve the effectiveness and the safety of the radiofrequency on the ganglion impar in the patient with perianal pain1, who did not respond to standard drug therapies2 Methods The case was a 79-year-old woman with history of continuous stabbing pain in the anal region. At her first visit, the VAS was 9/10. The patient was in the prone position on the operating table. After disinfection in the region of the sacral, a sterile echographic linear probe was placed transversely on the lower portion of the sacred until the identification of the sacral cornets. Then, the probe is rotated in a longitudinal position until the identification of the sacrococcygea joint.Under constant ultrasound guidance and fluoroscopy, a 22 G 100 mm radiofrequency needle was introduced in the precoccigeo space near the ganglion impar. The position of the needle tip was confirmed by injecting 1 mL of radiopaque dye in the retroperitoneal space.Then, a thermocouple connected to a radiofrequency generator was inserted to reproduce the patient‘s paresthesia via sensitive stimulation, 0.4–0.5 mV. The radiofrequency was performed at 90°C for 90 seconds. Results At the end of the procedure the patient reported VAS 0. Conclusions The result suggests that ultrasound guided combined with fluoroscopy enhances the safety and accuracy of radiofrequency on the ganglion impar. Furthermore, it significantly reduces radiation exposure for both patients and operator.