A ganglion impar injection is used to diagnose and manage visceral or sympathetic-maintained pain in the perineal and coccygeal areas.

Here are 3 pro tips to perform a ganglion impar injection

1. Place the transducer transversely in the midline to obtain a transverse view of the sacral hiatus. 
2. Rotate the transducer 90° to get a longitudinal view of the sacral hiatus and coccyx. The sacrococcygeal joint is the first cleft caudal to the sacral hiatus. 
3. Insert a 22- to 25-gauge needle out-of-plane into the sacrococcygeal joint.

Sonoanatomy

Reverse Ultrasound Anatomy

Comparison of sonoanatomy and reverse ultrasound anatomy for a ganglion impar injection.

Download the US Pain App HERE to read other tips on managing acute and chronic pain and to access the complete guide to ultrasound-guided chronic pain blocks.