| Case Report | Korean J Pain Vol. 23, No. 1, 2010 pISSN 2005-9159 / eISSN 2093-0569 DOI：10.3344/kjp.2010.23.1.65 -A Case Report- Ganglion Impar Block With Botulinum Toxin Type A for Chronic Perineal Pain Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea Su Jin Lim, MD, Hue Jung Park, MD, Sang Hoon Lee, MD, and Dong Eon Moon, MD Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A. (Korean J Pain 2010; 23: 65-69) Key Words: botulinum toxin type A, ganglion impar. 　　Chronic perineal pain is difficult to treat because the perineum consists of various anatomic structures, sym- pathetic nerves, and somatic nerve fibers [1]. For the treatment of perineal pain, blockage of the ganglion impar, which is located in the most inferior aspect to the sym- pathetic nervous system, has been introduced. Since then, blockage of the ganglion impar has been used to treat dis- eases, such as perineal or perianal malignant pain, ex- cessive perianal sweating, rectal tenesmoid pain, and coc- cygodynia [1-3]. To achieve blockage of the ganglion im- par, the following methods exist: local anesthetics, con- comitant use of local anesthetics and steroids, neurolysis by the use of alcohol or phenol, and radiofrequency abla- tion [4]. We performed blockage of the ganglion impar us- ing Botulinum toxin type A (BoNT-A). The mechanism of action of BoNT-A involves blockage of acetylcholine secre- tion by binding to the presynaptic nerve ending. BoNT-A has therefore been used to treat diseases associated with excessive muscle contraction [5]. In recent years, attempts have been made to use BoNT-A for the treatment of dis- Received November 8, 2009. Revised November 26, 2009. Accepted December 17, 2009. Correspondence to: Dong Eon Moon, MD Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: ＋82-2-2258-2235, Fax: ＋82-2-537-1951, E-mail: demoon@catholic.ac.kr This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ⓒ The Korean Pain Society, 2010