Indications et techniques des blocs neurolytiques en cancérologie pelvienne évolutive

In France pelvic cancers are frequent (prostate, bladder and cervix). Pelvic pain stemming from cancer is often a combination of somatic, visceral and neuropathic pain (70%). Classical cancer pain management (WHO) is also needed but some patients do not obtain adequate relief of pain despite aggressive efforts at pharmacologic management. The treatment of such pain requires careful clinical analysis and a truly multidisciplinary approach. Nerve blocks have an important historical and contemporary role in the management of pain. Neurolytic blocks are often appropriate choices in well-selected patients with pelvic cancer pain. Superior hypogastric plexus block (fluoroscopy, CTscan) is a very useful technique for the relief of exclusive pelvic pain (70% of reliable control of pain). Impar blocks (fluoscopy, CTscan) is a very useful technique for the relief of perineal pain (60% of reliable control of pain). Saddle block using phenol is a useful technique for the relief of pelvic and perineal pain in the patient with bowel and bladder dysfunction. The rehabilitation of this neurolytic blocks is needed with careful selection and meticulous attention to technical detail.