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
• Endometriosis
• 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%.