Pain associated with neoplasms may be of somatic, visceral, or neuropathic origin.Visceral pain or pain that is mediated by the sympathetic fibers in the perineal area associated with malignancy in the pelvis may be effectively treated with neurolysis of impar ganglion.In recent years, radiofrequency lesioning of the ganglion Impar has evolved as a novel non pharmacological technique for the management of patients suffering from intractable perineal pain.

Inclusion Criteria:

1. Cancer patients aged from 20-70 years old, with lower third cancer rectum, caner vulva, cancer vagina and cancer perineum.
2. The intensity of perineal pain on VAS score ≥ 5.
3. Unsatisfactory treatment with tramadol (400 mg daily) , Pregabalin (150 mg daily) or presence of side effects of tramadol as headache, dizziness, constipation, rash, sweating, dry mouth.
4. Included participants should show adequate response to diagnostic ganglion impar block , i.e. reduction of VAS pain score > 50% at least for 2 hours.

Exclusion Criteria:

1. Infection of the skin at or near site of needle puncture.

2. Coagulopathy or prolonged bleeding time.

3. Drug hypersensitivity or allergy to the studied drugs.

4. Central or peripheral neuropathy .

5. Significant organ dysfunction as respiratory , liver or renal failure.

6. Any psychiatric illness that would interfere with the perception and the assessment of pain.

7. Vertebral anomalies.

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