Superior Hypogastric Block for Chronic Pelvic Pain

The superior hypogastric plexus block is used for the alleviation of chronic pelvic pain in people who have little relief with medications or who have experienced unpleasant side effects to oral medicines. This block is safe and effective for relieving chronic pain associated with the pelvic region.

What are sympathetic nerves?

The sympathetic nerves originate along the spinal column and extend to all smooth muscles and glands of the body. The superior hypogastric plexus are sympathetic nerves receive and send signals in the body, control involuntary movements, and control how the body reacts to certain environmental and physical changes.

What is the superior hypogastric plexus?

The superior hypogastric plexus contains nerves originating from the testes, penis, descending colon, rectum, prostate, perineum, vagina, vulva, uterus, bladder, and urethra. This plexus is a bundle of nerves in front of the lower vertebral column. These nerves extend to both sides of the lower third of the 5th lumbar and upper third of the 1st sacral vertebral bodies. The sympathetic nerves originate along the spinal column and extend to all smooth muscles and glands of the body.

What conditions are treated with the superior hypogastric block?

The superior hypogastric plexus bock relieves pain related to any of the structures it supplies. Common painful conditions treated with this block include:

  • Cancer of the pelvis
  • Interstitial cystitis
  • Endometriosis
  • Organ radiation injury
  • Chronic pelvic pain
  • Uterus cancer
  • Colon cancer
  • Testicular cancer

How is the superior hypogastric plexus block done?

When arriving at the surgical center, a nurse explains the procedure to you and has you sign a consent form. After an IV line is placed in your arm to administer a sedative, the nurse positions you on lying face down.

The Chicago pain management doctor cleans the lower back skin with an antiseptic, and numbs the skin and deeper tissues using lidocaine or bupivacaine (anesthetic). After the skin is numb, procedure needles are place near the superior hypogastric plexus using fluoroscopic guidance to assure needle placement. Contrast dye is injected to confirm correct position. The anesthetic is injected onto the nerves, and the procedure needle is removed.

What can I expect after the superior hypogastric plexus block?

Right after the superior hypogastric plexus block, a nurse will monitor your vital signs and condition as you awake from the sedation. Expect some mild soreness at the lower back region. Because the sedative was given, you will need to have someone drive you home. The nurse will assess for any complications before sending you home. These include blood vessel injury, seizures, and allergy to medications.

What is the expected outcome after the superior hypogastric plexus block?

After the procedure, each patient will experience some pain relief, but this varies from person-to-person. Some people experience pain relief that last up to 6 months, whereas others have pain relief that persist for years. The superior hypogastric block is a low risk, minimally invasive procedure used to provide long-term pain relief to patients with chronic pain of the lower abdomen, genital region, and pelvis. The sympathetic nerves are blocked with this procedure.

What are the types of superior hypogastric plexus blocks?

  • Basic block posterior approach – This block involves injecting a local anesthetic onto the nerves to alleviate pain. The needle is inserted through the skin of the lower back region.
  • Basic block anterior approach – This involves injecting an anesthetic onto the nerves, and the needle is inserted through the lower abdominal region.
  • Radioablation block – This involves use of a needle and electrode to create a high level of heat in order to remove nerve tissue.
  • Neurolytic block – This involves injecting a chemical neurolytic agent onto the nerves to destroy a portion of the nerve root. Agents used include phenol and absolute alcohol.
  • Transdiscal approach – This involves inserting a needle through the spinal discs to reach the targeted superior hypogastric plexus nerves.

Does the superior hypogastric plexus block work?

According to a recent study, the superior hypogastric plexus block had an 89% success rate for treating bladder cancer pain. Researchers found that selection of patients based on clinical and demographic variables may improve treatment outcomes, however.

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Kroll CE, Schartz B, Gonzalez-Fernandez M, et al. (2014). Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients. Clin J Pain, 30(1), 55-62.

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