Background: Various interventions including the superior hypogastric plexus block and ganglion impar block are commonly used for treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block through the transsacral approach under fluoroscopy, using a local anesthetics/ steroid combination for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described by Schultz in 2007. Neurolysis of the inferior hypogastric plexus could be useful for pelvic and perineal pain caused by cancer.
Objectives: Assessment of the feasibility, safety, and efficacy of using the newly introduced inferior hypogastric block by the transsacral approach for relief of cancer related pelvic and perineal pain
Methods: Injection of 6-8 ml of phenol 10% bilaterally, by passing a spinal needle through the sacral foramen to do the inferior hypogastric block in 20 patients with cancer pain in the pelvis and /or perineum. We measured VAS, sleep score, activity score, psychological score, and oral morphine (MST) consumption pre and post-procedure.
Results: Two patients of the twenty died during the follow-up period, so, they were excluded from the study. All patients presented with cancer related pelvic, perineal, or pelviperineal pain. The mean pain score was reduced from 7.22 (1.31) pre-procedural to 4.06 (1.73) post procedural (P<0.05). as well the mean morphine sustained release tablets (MST 30mg) consumption was reduced from 106.67 (32.90) mg to 63.33 (43.52) mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block.
Discussion and Conclusion: the approach provides a good alternative technique for the treatment of low pelvic and perineal cancer related pain. It requires more studies for evaluation and refinement of the technique using other radiological techniques.