An Unusual complication after ganglion impar block for chronic cancer pain management

Patients with advanced pelvic malignancies present with pain of varying severity. Their pain can be effectively managed using a systemic pharmacologic approach, including oral administration of morphine. However, morphine can lead to constipation, which may be especially troublesome in patients with rectal carcinoma. Neurolytic blocks such as of the ganglion impar may alleviate sympathetically mediated pain and help in reducing opioid requirement. However, use of a ganglion impar block may rarely be associated with side effects such as rectal puncture, neuritis, and cauda equina syndrome. We report a rare neurologic complication after a fluoroscopic-guided ganglion impar block.