Superior hypogastric plexus neurolysis in a patient with a history of rectal cancer and severe unresponsive pain

Text A 71-year-old woman(with a history of TEM for rectal cancer) had a recurrence, treated with neoadjuvant CT+RT and subsequent surgery. After surgery, onset of severe pain (VAS score 9/10), described by the patient as deep pain, subcontinuous,unmodified by position changes.Pain specialists had tried various therapeutic strategies (also major opioids) with poor results. Then, we evaluated the patient for superior hypogastric plexus neurolysis EUS-guided.The technique consists of injection of Levobupivacaine 0.25% plus absolute dehydrate alcohol 95%.The patient had paradoxical increase of pain for 36 hours and no other complications;subsequently, pain relief weel managed with paracetamol every 6 hours.