Impar ganglion block with botulinum toxin in the management of perineal oncological pain: a case report

Chronic perineal pain is a common complication among patients with cancer. Due to the complex innervation of this anatomical region, pain management is often challenging and significantly impacts patients' quality of life. We present the case of an elderly patient with advanced-stage rectosigmoid junction adenocarcinoma who experienced severe coccygeal-perineal oncologic pain. Despite a multimodal analgesic treatment approach, the patient exhibited refractoriness to conventional pain management. Consequently, an interventional analgesic approach was implemented using an impar ganglion block with botulinum toxin type A (BoNT-A). Following the intervention, a significant reduction in pain intensity and opioid consumption was observed. This case highlights the therapeutic potential of the impar ganglion block with BoNT-A as an effective option for the management of refractory pelvic-perineal oncologic pain.