Ganglion Impar/Coccygeal Nerve Block

A ganglion of impar block is a minimally invasive procedure used to treat visceral, pelvic, genital, perineal and anal pain. This injection is a type of sympathetic block that can be used in the treatment of sympathetically-mediated pain, pain secondary to malignancy, neuropathic pain, and post-surgical pain.

This procedure may provide relief for patients who experience vague and poorly localized pain in the “seat” or tailbone region.

The procedure may be helpful in treating pain stemming from:

• Perineal pain
• Rectal/Anal pain
• Vulvodynia
• Scrotal pain
• Sympathetically-maintained pain to the region (i.e. Complex Regional Pain Syndrome)
• Coccygodynia
• Postherpetic neuralgia
• Burning and localized perineal
• Medial Branch Nerve Block

Medial branch nerves feed out of the spinal nerves’ dorsal rami and typically possess only sensory properties (except for some small branches in the neck that control small muscles). Medial branch nerves innervate the facet joints. All joint segments below C2-C3 receive medial branch innervation from two levels—the same level as the joint and from a level above the joint.

Diagnostic medial branch nerve blocks are the injection of an anesthetic medication in order to accurately locate the painful facet joint or the corresponding medial branch nerve(s).

Fluoroscopy or ultrasound guidance is done to guide the needle to the accurate treatment region. A contrast dye may be used to enhance the visualization of the joint and/or nerves.

Genicular Nerve Blocks

This minimally invasive outpatient procedure is an injection of anesthetic to the genicular nerves. These are the sensory nerves that transmit pain signals from the knee to the brain. Anesthetizing these nerves can disrupt the pain signals caused by degeneration of the knee.

The knee block procedure is primarily used as a diagnostic treatment to determine which nerves are causing the pain and if nerve blocking works. If the nerve block is successful, pain relief begins within an hour, but the relief is short-lived. The nerve block’s effects last from eight hours to a maximum of 24 hours. If the first block works, the diagnostic test may be performed a second time before the next step is taken.

Generally, if pain is reduced by at least 50% for the duration of the local anesthetic used, the physician knows that blocking certain nerves does work and will proceed with a longer-lasting treatment called a radiofrequency ablation of genicular nerves. The procedure is performed fluoroscopic or ultrasound guidance for safety and accuracy.

Occipital Nerve Block

The greater occipital nerve arises from between the first and second cervical vertebrae, along with the lesser occipital nerve. It supplies sensation to the skin along the back of the scalp to the top of the head.

When the occipital nerve is irritated, the pain of this irritation is felt along the back of the head spreading along the top of the head to near the eye of the same side of the nerve causing the pain.

These nerves may also contribute to headaches. Sometimes blocking (numbing) the occipital nerve will reduce the pain and headache.

During the nerve block, anesthetic medicine is injected to the region where the nerve crosses the skull. The needle is placed near the nerve and the anesthetic (or a combination of anesthetic and steroid) are injected. The procedure may be performed with fluoroscopy (x-ray) or ultrasound guidance, or done blindly (without image guidance).

An occipital nerve block is done to manage pain that affects the back of the head or one side of the head. People who have sensations of shooting, stinging or burning pain usually have the best response to the procedure. This procedure may help patients with pain that affects the back of the head or one side of the head.