David S Jevotovsky, Harman Chopra, Daniel J Pak, Eric A Grin, Adhith Palla, Shravani Durbhakula, Sidharth Sahni, Tariq AlFarra, Mustafa Y Broachwala, Anuj Shah, Richard Lau, Alexander Shustorovich, Michael Flamm, Melissa Murphy, Timothy Deer, Amitabh Gulati, Vwaire Orhurhu
{"title":"Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis.","authors":"David S Jevotovsky, Harman Chopra, Daniel J Pak, Eric A Grin, Adhith Palla, Shravani Durbhakula, Sidharth Sahni, Tariq AlFarra, Mustafa Y Broachwala, Anuj Shah, Richard Lau, Alexander Shustorovich, Michael Flamm, Melissa Murphy, Timothy Deer, Amitabh Gulati, Vwaire Orhurhu","doi":"10.1136/rapm-2024-106055","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/importance: </strong>Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.</p><p><strong>Evidence review: </strong>A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.</p><p><strong>Findings: </strong>Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3-6 months) and long-term (greater than 6 months) follow-up. SMDs were -2.73 (95% CI -3.45 to -2.01), -3.22 (95% CI -2.82 to -1.45), -1.86 (95% CI -2.58 to -1.15) at 3 months, 3-6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated 'very low' certainty of evidence across all outcomes.</p><p><strong>Conclusions: </strong>Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.</p><p><strong>Prospero registration number: </strong>CRD42024506056.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Regional Anesthesia and Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/rapm-2024-106055","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background/importance: Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.
Objectives: To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.
Evidence review: A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.
Findings: Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3-6 months) and long-term (greater than 6 months) follow-up. SMDs were -2.73 (95% CI -3.45 to -2.01), -3.22 (95% CI -2.82 to -1.45), -1.86 (95% CI -2.58 to -1.15) at 3 months, 3-6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated 'very low' certainty of evidence across all outcomes.
Conclusions: Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.
背景/重要性：慢性尾骨痛是一种具有挑战性的疾病。关于神经节阻滞在尾骨痛觉中的作用，存在着相互矛盾的证据。当保守治疗失败时，在神经节处的微创干预可能有效地提供缓解。目的：评价神经节阻滞（GIBs）治疗慢性尾骨痛的有效性和安全性。证据评价：根据系统评价和荟萃分析指南的首选报告项目进行了系统评价和荟萃分析。2024年2月，通过PubMed、Embase Classic+ Embase、CINAHL和Web of Science的综合文献检索，发现相关研究。提取患者特征、干预细节、疼痛结局（通过视觉模拟量表和数值疼痛评定量表测量）和不良事件的数据。采用标准化平均差异（SMDs）在0到10的范围内进行meta分析。结果：17项研究描述了625例接受GIB治疗的尾骨痛患者。所有的研究都报告了GIB后疼痛有一定程度的改善。荟萃分析包括11项研究，共计391例患者，基线疼痛评分为7.93 （95% CI为7.81至8.04）。GIBs在短期（3个月以内）、中期（3-6个月）和长期（6个月以上）随访中均能有效减轻尾骨疼痛。3个月、3-6个月和6 -6个月时，smd分别为-2.73 （95% CI -3.45至-2.01）、-3.22 （95% CI -2.82至-1.45）、-1.86 （95% CI -2.58至-1.15）。未发现严重不良事件。建议评估、发展和评估的分级评估表明，所有结果的证据确定性“非常低”。结论：非神经破坏性GIB可能是慢性难治性尾骨痛患者的一种安全且潜在有效的治疗选择。普洛斯彼罗注册号：CRD42024506056。
期刊介绍：
Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.
Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
