Superior Hypogastric Plexus Block

A Superior Hypogastric Plexus Block is a procedure to help provide relief to patients suffering from the severe and chronic pain associated with cancer of the pelvis as well as non-malignant conditions associated with the pelvis. Pelvic pain may not be very responsive to oral opioid pain medications. This treatment is performed by numbing the superior hypogastric plexus, a cluster of nerves situated in the lumbar region of the spine (lower back).

What conditions are treatable with a superior hypogastric plexus block?

The superior hypogastric plexus block is used to relieve pain in the pelvis region that is caused by malignant and non-malignant tumors in the pelvic region. The procedure is often used to relieve pain from endometriosis, and radiation injury, and to relieve pain of the urethra, bladder, vagina, uterus, vulva, perineum, prostate, testes, penis, descending colon and the rectum.

The plexus block may work exceptionally well after surgery in the pelvic area where the patient has significant adhesions (scar tissue). Pain after a prostatectomy may respond well, so it is not just females who are indicated.

How is the superior hypogastric plexus block performed?

The patient lies face down on a table that allows x-rays to go through it, and vital signs are monitored via EKG, pulse monitor and oxygen monitor. The patient may be sedated if necessary. The area to be injected is cleansed with anti-septic solution and numbed with a local anesthetic to numb the tissue in the injection site.

A contrast dye is injected to identify the area to be injected and then with the aid of a fluoroscope (a type of x-ray machine) to guide the needle, the medications are injected into the area around the plexus. Often a preliminary injection of local anesthetic will be used to determine if the patient will benefit from a superior hypogastric plexus block, if it is determined that the procedure will be effective a more permanent analgesic will be injected (such as phenol). After the procedure has been completed the patient will be placed in an observation area to watch for an allergic reaction to the medications.

How long do the effects of a superior hypogastric plexus block last?

Due to the fact that people react differently to the medications, the duration of the benefits of the procedure cannot be anticipated. The effects may last only for a couple of weeks or may last for a year or more.

The good news is if the injection works well, it may be repeated with the expectation that a repeat procedure will help as well.

How successful is the superior hypogastric plexus block injection for the relief of pain?

More than 70% of patients who received the superior hypogastric plexus block experienced a reduction in pain levels of 50%. For many of these patients, a successful superior hypogastric plexus block also resulted in a reduction in opioid analgesic use by up to 40%.

The injection may provide relief for a few weeks, or relief may last for months at a time. The procedure may be repeated at regular intervals as necessary.

What risks or side effects are associated with a superior hypogastric plexus block?

The superior hypogastric plexus block injection is a very low-risk procedure, but there is always some chance of side effects from the medications. You may experience soreness, bruising, or slight bleeding at the injection site. Very rarely an infection may occur. Even more rarely is the chance of nerve damage from the needle but this is very unlikely due to the use of the fluoroscope guidance during the procedure.

What is the bottom line of the superior hypogastric plexus block injection procedure?

The superior hypogastric plexus block injection is a low-risk, high benefit procedure for patients with a very frustrating condition – pelvic pain. To determine if this procedure could benefit you, discuss with your Chicago pain doctor to see if you are a candidate.