Does local anesthetic relief predict response to coccygectomy?

  • I’d like to clarify… absolutely I do say that it is important to notice how much relief there is during the 1st hour or so after a local anesthetic injection.
  • If a local anesthetic injection at the coccyx is done under image guidance (such as fluoroscopy, thus confirming accurate/appropriate placement of the injection) and the patient does NOT have any relief AT ALL, this becomes highly suspicious for the pain coming from anatomical areas/structures OTHER than the coccyx (or at least OTHER than the area on the coccyx where the local anesthetic block was placed).
  • The vast majority of patients do well with injections, without the need for surgery.
  • But, unfortunately, yes, some patients do indeed require surgery. And, for those deciding about surgery, while there is of course never any guarantee of a good outcome (nor with cushions, oral medications, injections, etc., either), those who have no relief at all from the local anesthetic block of the coccyx are the individuals who I am most concerned that the pain may be coming from someplace OTHER than the coccyx, in which case surgically removing the coccyx of course would NOT be likely to help.
  • I know it is a subtle clarification from how I phrase it, but I am NOT saying that coccydynia patients who get relief from local anesthetic should get a coccygectomy. I don’t want people to get the wrong impression and think that anyone who gets a local anesthetic injection and has initial relief should then go on for surgery.
  • Rather, most people after injections will never need surgery. But for those who do end up failing to get adequate relief from injections and other nonsurgical treatments, and if someone is considering surgery… then… if someone does NOT get any relief from local anesthetic blockade of the coccyx, then they are LESS likely to get relief from surgical removal of the coccyx.

– Patrick Foye, M.D.

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Patrick Foye, M.D.
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