injection itself. Neurolysis is commonly performed only after a successful celiac plexus block. CPN and celiac plexus block (CPB) are different in that CPN is permanent ablation whereas CPB is temporal pain inhibition. There are multiple posterior percutaneous approaches, but no clinical evidence suggests that any one technique is more efficient than the rest. The posterior approaches generally utilize two needles, one at each side of the L1 vertebral body pointing towards the T12 vertebral body. Increasing the spread of the injection may increase the efficacy of the neurolysis. Endoscopic ultrasound-guided neurolysis Endoscopic ultrasound (EUS)-guided neurolysis is a technique that performs neurolysis using a linear-array echoendoscope. The EUS technique is minimally invasive and is believed to be safer than the traditional percutaneous approaches. EUS-guided neurolysis technique can be used to target the celiac plexus, the celiac ganglion, or the broad plexus in the treatment of pancreatic cancer-associated pain. EUS-guided celiac plexus neurolysis (EUS-CPN) is performed with either an oblique-viewing or forward-viewing echoendoscope and is passed through the mouth into the esophagus. From the gastroesophageal junction, EUS imaging allows the doctor to visualize the aorta, which can then be traced to the origin of the celiac artery. The celiac plexus itself cannot be identified, but is located relative to the celiac artery. The neurolysis is then performed with a spray needle that disperses a neurolytic agent, such as alcohol or phenol, into the celiac plexus. EUS-CPN can be performed unilaterally (centrally) or bilaterally, however, there is no clinical evidence supporting the superiority of one over the other. EUS-guided neurolysis can also be performed on the celiac ganglion and the broad plexus in a similar fashion to the EUS-CPN. The celiac ganglion neurolysis (EUS-CGN) is more effective than EUS-CPN and broad plexus neurolysis (EUS-BPN) is more effective than EUS-CGN. Lumbar sympathetic neurolysis Lumbar sympathetic neurolysis is typically used on patients with ischemic rest pain, generally associated with nonreconstructable arterial occlusive disease. Although the disease is the basis for this type of neurolysis, other diseases such as peripheral neuralgia or vasospastic disorders can receive lumbar sympathetic neurolysis for pain treatment. Lumbar sympathetic neurolysis is performed between the L1-L4 vertebrae with separate injections at each vertebra junction. The chemicals used for neurolysis of the nerves cause destructive fibrosis and cause a disruption of the sympathetic ganglia. The vasomotor tone is decreased in the area affected by the neurolysis, which in addition to arteriovenous shunting,