Anococcygeal Approach for Coccydynia by a Bent Needle

Coccydynia has been currently treated by Ganglion Impar Block with some successes. It is usually approached through sacrococcygeal joint (SCJ) or anococcygeal ligment. Two cases with typical coccydynia are reported. Their pain was refractory to current medical and rehabitational therapy. They both showed the most painful complaint over the ventral side of the last coccygeal joint. Ligmentitis were impressed but direct injection by a regular straight needle was impossible. A 23 G long needle was then made bent to facilitate anococcygeal approach as modified from Plancarte's method. In both cases, the needle was advanced shortly (less than 1 cm) and triggered similar pain that was complained of by patients. At the very target, triamcinolone 5 mg in 0.25% bupivacaine 0.5 ml was injected. Coccydynia was successfully relieved in both cases instantly and did not recur after following up for 3 months at least.Concerning about injection sites and volume, our approach should not be truely classical Ganglion Impar Block which may relieve sympathetic nerve mediated perineal pain. We only use Plancarte's ventral approach for intractable pain over last coccygeal joint.