Fluoroscopic &Ultrasonographic Guidance of Superior Hypogastric Plexus Neurolysis in Intractable Pelvic Pain

The Role of Double Modality " Fluoroscopic &Ultrasonographic " Guidance of Superior Hypogastric Plexus Neurolysis in Treating Intractable Pelvic Cancer Pain: a Comparative Study.

fluoroscopic group & includes 30 patients where SHPB will be done Fluoroscopic-guided (the posterior oblique trajectory technique.the double modality group & includes 30 patients where SHPB will be done using our described new technique of performing the modified Mishra technique by injecting 3-5 ml of contrast media (lohexol=omnipaque) after getting the target position.

Inclusion Criteria:

• Age > 18 years.
• Intractable pelvic cancer pain (VAS > 40 mm)
• Pain is refractory to pharmacotherapy (both opioids and adjuvant therapy) or opioids' side effects are not tolerated.

Exclusion criteria

• Local or systemic sepsis.
• Uncorrectable coagulopathy.
• Neuropsychiatric illness.
• History of drug abuse.
• Pregnant or lactating patients.
• Distorted local anatomy.
• Patients who are known to be allergic to the used medications.
• Cardiovascular or respiratory instability.