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Background Cancer-related pelvic pain can be difficult and debilitating to treat. Superior hypogastric plexus neurolysis (SHPN) is a good choice for adequate pain relief with fewer side effects. The current study compared between fluoroscopic anterior approach and ultrasound guided SHPN in the management of cancer-related pelvic pain. Methods Patients were randomly allocated into two equal groups. The ultrasound group (US group) (n = 48) received SHPN by an ultrasound-guided anterior approach using 3 ml 5% bupivacaine plus 20 ml 10% phenol, while the fluoroscopy group (n = 48) received SHPN by a fluoroscopy-guided anterior approach using 3 ml 5% bupivacaine plus 20 ml 10% phenol. Results The time of the procedure was shorter in the fluoroscopic group (21.31 ± 4.79 min) than the US group (24.88 ± 6.02 min) (P = 0.002). Patient satisfaction was higher in the fluoroscopy group (5.38 ± 1.482) than the US group (2.98 ± 1.495) (P˂0.001). The need for analgesia using morphine was significantly limited in each group, at 1, 2 and 3 months intervals (P1˂0.001, P2 ˂0.001 and P3 ˂0.001). There were statistically significant differences between both groups regarding fatigue at baseline, drowsiness at 3 months, nausea and vomiting at 1, 2 and 3 months and anorexia at 3 months. Group comparison also revealed statistically significant differences regarding depression at one month, anxiety at 2 and 3 months and insomnia at baseline. Conclusion The fluoroscopic anterior approach SHPN was more superior than the US guided SHPN regarding the time of the procedure and patient satisfaction, while both technique were similar regarding the numeric rating scale and the complications during block. Trial registration Registered in the ClinicalTrials.gov (Identifier: NCT05299047) at 28/03/2022.

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Background Cervical facet joints are considered one of the causes of chronic posterior neck pain by 54–67%. Cervical medial branch nerve blocks (CMBB) or neurolysis and intra-articular injections have been described for relieving the neck pain originate from facet joint. Methods Patients were randomly allocated into one of two groups: CMBB group where CMBB was performed at the affected dermatomal level and one level above using 0.5 mL dexamethasome (8mg/2ml) and 0.5 mL 1% lidocaine in each level, while in the cervical retrolaminar block (CRB) group, CRB was performed using 2 mL dexamethasone (4mg/1ml) and 3 mL 1% lidocaine for each affected dermatomal level. Numerical rating score (NRS) was carried out for all patients before the procedure, 2 weeks, 2 and 3 months after the procedure (where zero equals no pain and 10 equals the worst pain). Neck Disability Index (NDI) was done before the procedure and 2 weeks after the procedure. Any complication has been monitored as vascular injury, pneumothorax and epidural or spinal injection. Results NRS and NDI improved in both group with no statistically significant difference between them. The time of the procedure was shorter in CRB group, while the vascular injury was higher in CMBB group. Conclusions CRB is a good alternative to CMBB in the management of cervical facet joint pain with similar pain relief, better NDI, shorter time of procedure and no serious complications. Trial registration: registered in the clinical trials.gov (NCT05184881 ) at 11/01/2022