Blocks of the ganglion impar are used to treat both malignant and benign causes of visceral and sympathetic pelvic and perineal pain. While conventionally done under fluoroscopic guidance, significant improvements in transducer technology in the past decade have piqued the interest and enthusiasm of interventional pain specialists toward ultrasound-guided performance. In the setting of a pandemic, it is important to ensure the efficacy of treatment as well as the safety of both patients and health care workers. This paper presents two patients who underwent two approaches of ultrasound-guided ganglion impar blocks in a tertiary government hospital in the Philippines during the COVID-19 pandemic.

More than 80% of cancer-related pain is pharmacologically controllable, whereas 10~20% of patients require interventional treatments. Neurolytic nerve block can play a major role in cancer pain treatment, and it has been proposed to prevent the development of pain and improve the quality of life of patients with cancer. If the pain is well localized and restricted to certain peripheral parts of the body, spinal peripheral or sympathetic nerve blocks may result in excellent therapeutic effects. Neurolytic sympathetic block, especially Celiac plexsus block (CPB) performed in earlier stages, is effective with successful long term results. However, selection of patients is critical for succeful outcomes. Neurolytic plexus block significantly improves the quality of life of patients and reduces abdominal and pelvic cancer pain, analgesic consumption and adverse opioids-related side effects. Interventional pain management should be considered at earlier stages to provide patients with the best quality of life possible.
Autonomic Nerve Block ; Humans ; Nerve Block ; Pain Management ; Pelvic Neoplasms ; Quality of Life

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema.
Arm ; Autonomic Nerve Block ; Breast Neoplasms* ; Humans ; Lymphedema* ; Mastectomy ; Nerve Block ; Pain Clinics ; Stellate Ganglion* ; Upper Extremity

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.
Anesthetics, Local ; Autonomic Nerve Block ; Humans ; Hypogastric Plexus ; Nerve Block ; Pelvic Pain ; Sympathetic Nervous System ; Viscera ; Visceral Pain

With prolonged life expectancy and economic development, most people want a good quality of life. In this regard, the pain control becomes an important part in the medical care in addition to the treatment of the disease per se. Anesthesiologists have been practicing pain medicine for decades, with the unique application of specific nerve blocks. Pain clinic is a specialized department for pain management. The main therapeutic modality practiced at pain clinics in Korea is the nerve block. Nerve block is performed by an injection of an anesthetic or destructive substance hear a nerve or nerve plexus to interrupt its function for a brief or extended period, respectively. Nerve blocks play an important role in diagnosis, prognosis, and treatment of chronic pain. Nerve block intercepts the vicious cycle of pain as well as takes off the pain. Moreover, by improving the local blood flow, it also has an indirect effect on the treatment of pain. Sympathetic nerve block is used not only for pain relief, but also for the treatment of disease mainly accompanying sympathetic hyperactive symptoms. Pain clinic manages several kinds of intractable chronic pain. The rise in the number of pain clinics increases awareness of chronic pain with a considerable impact on our society.
Autonomic Nerve Block ; Chronic Pain ; Diagnosis ; Economic Development ; Korea ; Life Expectancy ; Nerve Block ; Pain Clinics* ; Pain Management* ; Prognosis ; Quality of Life

This study analyzed the effects of treatment by stellate ganglion block, epidural block and intercostal block on 34 patients suffering from herpes zoster and postherpetic neuralgia at the Division of Pain Clinic, Department of Anesthesiology, Chonnam National University Hospital during the last two years. 1) The freguency of occurrence the frequency of sex and the lesion side, right or left side of the trunk, were similar in all patients. 2) The most frequent age of incidence was between 50 and 70 years old (62%) 3) The most frequent site of lesions was the thorax (55%) 4) The earlier the treatment and the younger the patients were, the more satisfactory were the results of the nerve blocks. 5) Sympathetic nerve block, stellate ganglion and epidural blocks were more effective than somatic nerve blocks or intercostal blocks. 6) There was no relationship between the number of nerve blocks and the effect of the treatement.
Aged ; Anesthesiology ; Autonomic Nerve Block ; Herpes Zoster ; Humans ; Incidence ; Jeollanam-do ; Nerve Block ; Neuralgia, Postherpetic* ; Pain Clinics ; Stellate Ganglion ; Thorax

This study analyzed the effects of treatment by stellate ganglion block, epidural block and intercostal block on 34 patients suffering from herpes zoster and postherpetic neuralgia at the Division of Pain Clinic, Department of Anesthesiology, Chonnam National University Hospital during the last two years. 1) The freguency of occurrence the frequency of sex and the lesion side, right or left side of the trunk, were similar in all patients. 2) The most frequent age of incidence was between 50 and 70 years old (62%) 3) The most frequent site of lesions was the thorax (55%) 4) The earlier the treatment and the younger the patients were, the more satisfactory were the results of the nerve blocks. 5) Sympathetic nerve block, stellate ganglion and epidural blocks were more effective than somatic nerve blocks or intercostal blocks. 6) There was no relationship between the number of nerve blocks and the effect of the treatement.
Aged ; Anesthesiology ; Autonomic Nerve Block ; Herpes Zoster ; Humans ; Incidence ; Jeollanam-do ; Nerve Block ; Neuralgia, Postherpetic* ; Pain Clinics ; Stellate Ganglion ; Thorax

Interscalene bracheal plexus block has became a popular method of anesthesia for surgical operation on the upper extremities. Possible complications are subarachnoid block, epidural block, phrenic nerve block, vagus or recurrent laryngeal nerve block, sympathetic nerve block, intravascular injection. But reported complications has been few and generally without prolonged effects. The following describes a patient who developed signs and symptoms suggestive of inadvertent phrenic nerve block and epidural anesthesia as complications of interscalene bracheal plexus block The complications were attributed to using of inferomedially directed 5 cm needle and then additional blind block of the brachial plexus with 5 or 6 times. We emphasize that if the appropriate length of needle and technique are not used, phrenic nerve paralysis and serious complications including total spinal or epidural block can occur as a result of a medially misdirected needle.
Anesthesia ; Anesthesia, Epidural ; Autonomic Nerve Block ; Brachial Plexus ; Humans ; Needles ; Paralysis* ; Phrenic Nerve* ; Recurrent Laryngeal Nerve ; Upper Extremity

Hyperreflexic bladder is a disease manifested in patients with spinal cord lesions above the sacral segment. The treatments for hyperreflexic bladder are medical therapy, interruption of innervation, argumentation cystoplasty, etc. We treated four hyperreflexic bladder patients with 12% a phenol injection into the subarachnoid space for sacral nerve block. Before treatment the average bladder capacity was about 100 ml, and there was one case of autonomic dysreflexia. After the subarachnoid block the average bladder capacity increased above 300 ml and maximal intravesical pressure decreased below 30cmH2O, autonomic dysreflexia disappeared in one patient. The decreased bladder compliance after nerve block was managed by repetitive bladder overdistention. We suggest that subarachnoid block is easier and more effective than sacral nerve block individually, and is a treatment for hyperreflexic bladder refractory to medical therapy.
Autonomic Dysreflexia ; Compliance ; Humans ; Nerve Block ; Phenol ; Spinal Cord ; Subarachnoid Space ; Urinary Bladder*

Since May 1976, 16 cases of herpes zoster were treated, mainly by repeated stellate ganglion or epidural block with 1% lidocaine. These cases were divided into two groups depending on the duration of herpes zoster, within 2 weeks (group 1) and 2 weeks to 2 months (group 2). The results were as follows: 1) No significant differences of sex and age distribution in the two groups were observed. The youngest case was 12 years old, the oldest 80 years and 87. 5% of cases were above the age of 50. 2) The left side was slightly more often involved. The highest incidence was observed in the thoracic region (62.5%) and in 1 or 2 segments (75%). 3) Blocks, repeated more than four times, were needed for the complete relief of pain in group 1. 4) The effect of repeated blocks was excellent in early cases. The above results indicate that repeated sympathetic blocks, more than 5 times, were effective for early cases of herpes zoster.
Age Distribution ; Autonomic Nerve Block* ; Child ; Herpes Zoster* ; Humans ; Incidence ; Lidocaine ; Stellate Ganglion