241: Innovative Cost-Effective Hyperosmolar Dextrose Ganglion Impar Block for Post-Traumatic Coccydynia

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic posttraumatic pain, Pharmacological treatments, Drug development, Treatment/management

Background and Aims: Background:
Chronic post-traumatic coccydynia frequently remains refractory to conservative and interventional management, particularly in the presence of structural abnormalities such as coccygeal subluxation or abnormal angulation. Ganglion impar block (GIB) is an established intervention for sympathetically mediated coccygeal pain. However, traditional neurolytic agents such as alcohol or phenol are limited by safety concerns, including non-selective tissue necrosis and higher costs.

Methods: Case Report:
We report a 51-year-old woman with chronic post-traumatic coccydynia secondary to sacrococcygeal subluxation and angulation who underwent a fluoroscopy-guided ganglion impar block using 20% hyperosmolar dextrose (D20W). Baseline pain severity was Numeric Pain Rating Scale (NPRS) 9/10. Immediate and complete pain relief was achieved (NPRS 0/10) without procedural complications. At 3-year follow-up, the patient remained asymptomatic, demonstrating sustained symptom resolution. This report contextualizes the intervention by integrating current anatomical knowledge of the ganglion impar and existing evidence on the osmotic and neuromodulatory effects of hyperosmolar dextrose, emphasizing its potential as a safe, cost-effective neurolytic alternative to conventional agents.

Results: Discussion:
The clinical effectiveness observed in this case can be attributed to the anatomical and functional role of the ganglion impar as the terminal sympathetic nociceptive relay, together with the selective neurolytic effect of hyperosmolar dextrose mediated through osmotic mechanisms rather than chemical ablation or tissue necrosis. With an osmolarity just above the experimentally defined neurolytic threshold, D20W is capable of safely disrupting sympathetic pain transmission and may induce a sustained neuromodulatory effect over the long term.

Conclusions: Conclusion:
Hyperosmolar dextrose offers a safe, low-cost, and widely accessible alternative to conventional chemical neurolytics for ganglion impar block, particularly in resource-limited settings. By achieving sustained long-term pain relief without the use of hazardous agents or specialized equipment, this approach highlights a pragmatic and resource-efficient strategy for managing refractory post-traumatic coccydynia. To our knowledge, this report represents the first documented use of hyperosmolar dextrose as a neurolytic agent in ganglion impar block for chronic post-traumatic coccydynia.
Keywords:
Coccydynia, Ganglion Impar Block, Hyperosmolar Dextrose, Innovative, Cost-Effectiveness, Safety, Long-Term Outcome.

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Presenting Author: Achmad Harun Muchsin
Submitting Author: Achmad Harun

Senior Author: Helen Gharaei

IASP 2026 Global Year theme of Neuropathic Pain: No

• Nirwana Fitriani Walenna: MD, Ph.D - Universitas Hasanuddin
• Helen Gharaei: MD - International Sonoguide Pain School
• King Hei Stanley Lam: MD - The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong