What is the superior hypogastric plexus?
The superior hypogastric plexus refers to the bundle of nerves and nerve branches that provide innervation to the organs of the pelvis. The organs innervated by the superior hypogastric plexus include the bladder, urethra, uterus, vagina, vulva, perineum, prostrate, penis, testes, rectum, and descending colon.
The superior hypogastric plexus is formed by the visceral afferent branches of the pelvis, the splanchnic nerves, and the sympathetic nerves from the aortic plexus. It can be found behind the retroperitoneum, right in front of the lumbosacral area of the vertebral column. It extends bilaterally from the lower third of the fifth lumbar vertebra to the upper third of the first sacral vertebra.
What does a superior hypogastric plexus do?
Degenerative conditions and the growth of malignancies in the visceral organs can cause progressively severe and debilitating pain from the pelvis. This eventually can become unresponsive to painkillers, or may require doses that are potentially harmful to the patient.
In these cases, the Chicago pain management doctor may opt to “stop” all the pain signals from the pelvis by performing a superior hypogastric nerve block. This procedure involves the injection of a local anesthetic near the superior hypogastric plexus: this prevents pain signals from getting through, and provides the patient relief of symptoms.
What conditions benefit from a superior hypogastric plexus block?
This procedure is typically recommended only after conservative options, such as oral painkillers, have been exhausted. Conditions that cause chronic and intractable pain, such as malignant growths and endometriosis have been treated with this procedure. Postoperative pain, such as from transurethral transection of the prostrate, has also been shown to respond to blocks of the superior hypogastric plexus.
Pain emanating from scar tissue due to previous surgeries can receive tremendous pain relief from a hypogastric block.
How is the superior hypogastric plexus block done?
The procedure is a nerve block, and can be done in an outpatient procedure room under
local anesthesia. General anesthesia is not typically recommended, although the patient may be sedated if necessary. Prior to the procedure, the needle insertion site will be prepped with an antiseptic solution such as povidone-iodine, or even chlorhexidine, and the surrounding area will be draped with surgical linen for a sterile field.
The two most common approaches to the superior hypogastrc plexus block are the posterior and transdiscal approaches. The posterior approach requires the patient to lay face down; if this position causes the patient too much stress, or is judged by the pain management doctor in Chicago to be infeasible, then the transdiscal approach is opted for instead.
What are the outcomes and risks of the procedure?
The superior hypogastric plexus block is a well-established procedure for the treatment of chronic pelvic pain, particularly those secondary to malignancy. Multiple studies have established that majority of patients will tolerate the procedure well, and will report favorable outcomes, such as reduced symptoms of pain.
The duration of the symptomatic relief varies from person to person, and a patient will likely require multiple blocks. Treatment with this procedure has been shown to decrease the need for opioid analgesics.
There are always risks associated with pain procedures, including infection of the injection site, bleeding, and intraoperative damage to muscles, nerves and soft tissue. However, these adverse outcomes are rare, and the procedure is generally considered safe.