ABSTRACT
Most patients with cancer pain can be treated using the World Health Organization analgesic stepladder. An interventional technique may be considered due to intolerance of systemic medications or pain despite optimal medical management. Peripheral nerve blocks are often used to address pain of somatic origin, and autonomic nerve blocks are reserved for suspected visceral or sympathetically mediated pain. Autonomic nerve blocks almost always block transmission of the sympathetic system. There is little evidence for a maximum safe international normalized ratio or minimum platelet count for neurolytic blocks. Celiac plexus blocks are among the most well-studied nerve blocks for cancer pain stemming from tumors of the pancreas, stomach, gallbladder, and liver. Patients with pelvic pain from gynecologic, colorectal, and bladder pelvic tumors may respond to superior hypogastric blocks. stellate ganglion blocks are typically used for sympathetically mediated pain of the head and neck, though there are also case reports and series supporting its use in palliative care patients for refractory angina.
