Disclosures: Katherine Chen, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 68-year-old female with a history of perineal and groin necrotizing fasciitis presented with persistent groin pain and was treated with ganglion impar block.

Case Description or Program Description: The patient is a 68-year-old female with a history of necrotizing fasciitis of the perineal/groin status post several reconstructive surgeries 1-2 years prior to presentation who complained of persistent throbbing pain in the right perineal/groin region, worse with movement. She presented to clinic after she was unable to tolerate Gabapentin and was placed on Hydrocodone and Fentanyl patch by a previous provider, which had been providing moderate relief. On exam, the patient’s right groin and perineum region revealed multiple healed surgical incisions. The right perineal scars were hyperesthetic. Palpation and mobilization of the area reproduced some of her pain. As she had failed conservative measures, two ganglion impar blocks under fluoroscopic guidance for coccydynia were performed several weeks apart, each with significant pain relief immediately following the nerve block.

Setting: Outpatient interventional pain clinic

Assessment/Results: Necrotizing fasciitis and multiple debridements and reconstructive surgeries in the perineum and groin likely led to sympathetic hyperactivity and a ganglion impar block was performed with significant improvement in her pain. A repeat ganglion impar block yielded similar results.

Discussion (relevance): Due to the area of the patient’s neuropathic pain and component of coccydynia, a ganglion impar block was performed which confirmed her pain was sympathetically-mediated rather than post-surgical pain.

Conclusions: Sympathetically-mediated groin and perineal pain should be considered in patients with persistent pain in the areas of recent extensive surgery, and a sympathetic nerve block can be both diagnostic and therapeutic.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/persistent-coccydynia-after-necrotizing-fasciitis-a-case-report/