Superior Hypogastric Nerve Block
Colorado Pelvic Pain Treatment
The superior hypogastric plexus block is used to provide pain relief to
the pelvic region. This block is only used when that patient does not
respond to pain medicines, or when chronic pain is problematic. The block
involves injecting an anesthetic or neurolytic agent onto the nerves of
the pelvic region.
What is the superior hypogastric plexus?
The superior hypogastric plexus is a bundle of nerves that are in front
of the vertebral column of the very low back (lumbar-5 and sacrum-1).
The superior hypogastric plexus contains efferent sympathetic nerve fibers
that supply signals to and from the urethra, uterus, bladder, vulva, vagina,
penis, testes, prostate, perineum, rectum, and descending colon.
What conditions are treated using the superior hypogastric plexus block?
According to pain management specialists, the superior hypogastric plexus
block is used to treat:
- Malignancy-associated anal-rectal pain
- Penile pain
- Metastasized cancer of the testicles, prostate, cervix, or colon
- Radiation injury
What can I expect before and after the procedure?
You will meet with the pain management specialist to discuss your treatment
options. Be sure to notify the doctor of all your health problems, allergies,
and medications. Arrange to have someone drive you home, because a sedative
is given during the procedure.
When you arrive at the surgical center, a nurse reviews the benefits and
risks of the procedure, has you sign consent forms, and has you change
into a gown. An IV catheter is placed in your hand, and the nurse places
monitoring devices on your hand and arm. After the procedure, you are
monitored in the recovery area. Expect some soreness at the needle insertion
site. You may also feel a warmth, fullness, or odd sensation in the pelvic area.
How is the superior plexus block performed?
The superior hypogastric plexus block is performed most often using the
posterior approach. The patient is positioned face-down on the procedure
table. After the skin is cleaned, the doctor numbs the injection site
with a local anesthetic. With the transdiscal approach, the procedure
needle is inserted through the skin and tissues of the lower back and
positioned near the plexus using x-ray guidance. With the anterior approach,
the patient is positioned on his/her back, and the needle is inserted
through the lower abdomen. The medication is injected onto the nerves,
the procedure needle is removed, and a bandage is placed over the site.
What are the benefits of the superior hypogastric plexus block?
The superior plexus block can:
- Offer long-term pain relief.
- Be performed in the doctor’s office in a minimally-invasive procedure.
- Only takes around 15 minutes to perform.
- Be performed under mild sedation rather than general anesthesia.
Does the superior hypogastric plexus block work?
The superior hypogastric plexus block is an effective procedure for chronic
pelvic and perineal area pain. In a study conducted in patients with malignancy-associated
chronic pelvic pain, the block had a 70% success rate for significantly
decreasing pain. Another study showed that the block offered success by
decreasing mean daily opioid use. A recent clinical trial assessed the
safety, efficacy, and feasibility of the superior hypogastric block for
treating perineal and pelvic pain caused by cancer. The transsacral approach
was found to offer reduction of pain scores and less consumption of pain
medicine in most subjects. In addition, the success rate was 73%.