Postoperative pain is a prevalent problem, often lasting from days to years. To minimize opioid use and associated risks of dependency, Enhanced Recovery After Surgery (ERAS) protocols increasingly incorporate multimodal analgesics. Sodium channel-selective blockers are a promising non-opioid alternative, yet their application in postoperative pain remains underexplored. This systematic review evaluates their efficacy in managing postoperative, neuropathic, and neuralgia-related pain. A systematic review was conducted using controlled keywords across multiple databases to identify studies on sodium channel-selective blockers published up to 2024. Eligible studies included clinical trials, observational studies, case series, and reports involving patients aged 18 or older. Data were extracted on therapeutic outcomes, dosages, complications, and comparisons with other analgesics. Five studies met the inclusion criteria, involving 804 patients, 81.58% of whom were women. One study addressed postoperative pain, while the remaining five focused on neuropathy- and neuralgia-related pain. All studies reported significant pain reduction in at least one treatment group compared with placebo. In the study on postoperative pain, the sodium channel-selective blocker significantly reduced pain scores without requiring opioid analgesia. Across all studies, only two patients needed concomitant opioid therapy, and one discontinued treatment due to adverse effects. Dosages varied, with no reports of severe complications. Comparative analyses showed that sodium channel-selective blockers were as effective, if not superior, to traditional pain medications in reducing pain intensity. Sodium channel-selective blockers demonstrate significant potential in pain management with minimal opioid reliance. While effective for neuropathic pain, further studies are essential to validate their role in acute postoperative settings and refine their use in multimodal analgesia regimens.

Primary extraskeletal pelvic Ewing sarcoma within gynecologic organs is extremely rare and current literature is limited to case reports or series. Definitive diagnosis requires molecular confirmation of the EWSR1 fusion gene which drives cancer proliferation. Current treatment is guided by the National Comprehensive Cancer Network (NCCN) guidelines for Ewing sarcoma of the bone. A previously healthy 21-year-old woman presented to her primary care provider with two weeks of malaise and pelvic symptoms. Imaging revealed a 10 cm heterogenous cystic and solid mass in the mid-pelvis appearing to arise from the anterior uterus with potential bladder invasion. She underwent exploratory laparotomy which included en bloc radical hysterectomy, bilateral salpingectomy, anterior vaginectomy, distal left ureterectomy, partial posterior cystectomy, and pelvic lymphadenectomy. Pathologic evaluation confirmed extraskeletal Ewing sarcoma through identification of an EWSR1 gene rearrangement. Margins were negative. The patient is undergoing adjuvant chemotherapy and PET scan 4.5 months postoperative showed no evidence of residual disease or metastasis. A comprehensive literature review identified 98 cases of molecularly-confirmed Ewing sarcoma occurring across gynecologic organs including the ovary, fallopian tube, broad ligament, uterine corpus, cervix, vagina, and vulva. Cases occurred in women across the lifespan. Treatment regimens and prognosis were variable. We present a unique case of primary pelvic extraskeletal Ewing sarcoma in a previously healthy young woman with localized invasion into the uterus, vagina, and bladder. Given the rarity of this disease, paucity of data, and potential for misdiagnosis, clinicians must maintain high suspicion for pelvic extraskeletal Ewing sarcoma.