Managing acute coccydynia in the ED: A case report of a successful blind sacrococcygeal nerve block

Abstract

Background

Acute traumatic coccydynia typically results from direct trauma and is an often overlooked but significant cause of discomfort that can present acutely in the emergency department (ED). First-line treatment including NSAIDs and acetaminophen aims to provide relief but can be insufficient. The sacrococcygeal nerve block, though underutilized in the ED, is a simple intervention using existing skills to provide pain relief. To our knowledge, this is its first documented use in the ED for coccydynia.

Case report

A 20-year-old female presented to the ED with severe coccygeal pain (10/10) following a fall five days prior. Conservative management of NSAIDs, acetaminophen and activity modifications from a prior ED visit failed to improve her symptoms, leaving her requiring significant daily bedrest. In the present ED visit, after failed opioid pain reduction, a sacrococcygeal nerve block was performed using dexamethasone and bupivacaine, resulting in complete pain resolution (0/10) within 15 minutes. The patient experienced 5 h of total relief, a 30 % reduction in pain by 18 hours, and 70 % reduction by week three. She resumed work within a week and reported satisfaction with the procedure.

Why Should an Emergency Physician Be Aware of This?

The sacrococcygeal nerve block is a time-efficient intervention for acute coccydynia that aligns well with the skillset and demands of the ED, although further research is required on its effectiveness in the ED setting prior to wide use. It can possibly provide immediate pain relief, reduce opioid requirements, and minimize repeat visits as discussed in this report.