Inclusion Criteria:  Age > 20 years. Patients with advanced stage cancer bladder. Patient with severe pain (VAS) 7 or more . Patients don't receive any strong opioids for pain at least 2 weeks  Exclusion Criteria:  Patient refusal. Local infection at the puncture site. Coagulopathy. Cognitive disorders. Unstable cardiovascular disease. History of psychiatric disorders. History of drug abuse. Patients allergic to medication used. Patients with any contraindications to drugs and dye used.