Pulsed radiofrequency of S2-4 nerve roots vs ganglion impar neurolysis for severe perineal cancer pain.

INTRODUCTION

Perianal and perineal-related cancer pain is deemed severe in most patients with cancer, and its management poses a significant challenge due to rich innervation of this region.

OBJECTIVES

This study compared the analgesic efficacy of bilateral selective pulsed radiofrequency (PRF) of sacral nerve roots (S2-S4) with ganglion impar neurolysis (GIN) in patients experiencing severe perianal and perineal cancer pain.

METHODS

Forty patients with severe perineal or perianal cancer pain, defined by a visual analogue scale (VAS) score ≥7, were randomized to 1 of 2 groups. Both procedures were performed under fluoroscopic guidance: the PRF group received bilateral selective PRF of sacral nerve roots (S2-S4), whereas the GIN group underwent ganglion impar neurolysis using a 6% phenol in saline injection. The primary outcome was the VAS score at 4 weeks.

RESULTS

Both groups showed significant reductions in VAS scores up to 12 weeks post-treatment compared to baseline (P < 0.001). The PRF group had significantly lower VAS scores than the GIN group at postanesthesia care unit, and at 1, 4, and 8 weeks (P < 0.05). Oxycodone and pregabalin consumption were lower in the PRF group at these intervals. The PRF group experienced a longer procedure duration and a higher incidence of injection site pain (P < 0.05). However, quality-of-life scores and patient satisfaction were significantly higher in the PRF group.

CONCLUSION

Bilateral PRF of sacral nerve roots (S2-S4) resulted in more analgesic efficacy and improved quality-of-life compared to GIN in patients with severe perineal and perianal cancer pain, despite higher rate of injection site discomfort.