Les blocs neurolytiques peuvent rendre des services irremplaçables chez certains patients cancéreux soigneusement sélectionnés, qui souffrent de douleurs résistant aux autres traitements disponibles. La meilleure indication est la neurolyse coeliaque et splanchnique pour les cancers digestifs sus-mésocoliques. La radicolyse intrathécale, est un bon choix pour les envahissements pelviens chez des patients porteurs d'une double stomie, urinaire et digestive. D'autres techniques ont des indications plus rares : plexus hypogastrique, ganglion impar… Les indications sont idéalement posées en staff pluridisciplinaire. La réalisation technique nécessite la plus grande rigueur. Un contrôle par l'imagerie de la diffusion des substances injectées sécurise la technique. Une information convenable du patient est indispensable.

There are several excellent indications for certain neurolytic blocks in patients with cancer-related pain which should be understood and undoubtedly more widely used. In certain cases, these techniques can, in terms of iatrogenesis and quality-of-life, offer a favorable alternative to medicinal analgesia, which is sometimes difficult to achieve and always involves risk. Indications should be determined in a pluridisciplinary setting and must be based on an excellent knowledge of the anatomy and physiology involved. Small volumes of neurolytic agents should be employed after careful identification of the injection site with appropriate imaging techniques. The patient must be informed of the objectives, the chances of success, and the possible inconveniences related to the proposed treatment. The patient must be informed of the risk of recurrence after a more or less long period. The chances a neurolytic block will be successful are greater for focal pain and visceral pain.

Intrathecal cauda equina radicolysis should only be proposed for patients suffering from pain related to recurrent or locoregionally invasive pelvic cancer with a double urinary and gastrointestinal stomy. Under these restrictive conditions, and in patients with a fair general status, intratecal cauda equina radicolysis can provide considerable gain in comfort and quality-of-life.

A celiac plexus block is the most effective and most widely used neurolytic block. A computed tomography scan should be performed to localize the injection point. Pain related to cancer of the pancreas is the best indication.

Neurolysis of the hypogastric plexus can be proposed for patients with pelvic cancer-related pain. New technical advances (anterior approach) have widened the indications.

Blockade of the ganglion impar is indicated for sympathetic-mediated perineal pain which is often accompanied by burning sensations and urinary or rectal urge. Using rigorous rules for indications, this simple and safe technique provides reliable pain relief. A neurolytic block should be entertained as a possible solution when an acceptable compromise between the analgesic and the undesirable effects of drugs cannot be reached. Satisfactory results can be expected with relatively minor and rare adverse effects. Rigorous indications and procedures, together with a quality patient-physician relationship and honest complete patient information, provide the best preventive scheme against medicolegal complications.