Superior Hypogastric Plexus Block


Apelvic painjpg superior hypogastric plexus block, also called the hypogastric block, is an advanced, minimally invasive procedure used to treat pain in the genitalia and pelvic region that does not respond to oral medications and conservative treatment measures.

The block involves an injection directly into the specific region of the sympathetic nervous system (SNS) known as the superior hypogastric plexus. This group of nerves transfer signals to the brain from the visceral and pelvic regions.

What is the superior hypogastric plexus?

The superior hypogastric plexus is a collection of nerves in the posterior peritoneal space behind the fifth lumbar intervertebral disc. This nerve bundle has both afferent and efferent nerve fibers, and provides innervation to the pelvic region and perineal area.

What conditions are treated with the superior hypogastric plexus block?

Numerous conditions can be treated with this block, including:

  • Chronic pelvic pain
  • Interstitial cystitisSuperior Hypogastric Plexus Block
  • Pain related to cancer
  • Endometriosis
  • Dysmenorrhea and dyspareunia
  • Myofascial pain syndrome
  • Prostatitis
  • Vulvitis
  • Cystitis
  • Pelvic congestion
  • Varicocele
  • Irritable bowel syndrome
  • Pelvic fibrosis
  • Pelvis neurodystonica
  • Pain related to adhesion

How is the procedure done? 

The superior hypogastric plexus block is an outpatient procedure, generally performed using a local anesthetic. Some patients, however, request IV sedation for increased comfort. The most common approach is the posterior approach, which involves inserting a needle into the back area.

The doctor cleanses the skin with an antiseptic, and numbs the skin and tissues with an anesthetic. Once numb, two thin needles are inserted under x-ray guidance in front of the lower back disc (lumbar 5/sacral 1). Once in position, a small amount of contrast dye is injected to verify placement.

superior hypogastric plexus blockOnce the doctor assures position, a small amount of a local anesthetic (and sometimes a neurolytic agent) is injected on the nerves. The entire procedure takes less than 15 minutes to perform. Once the doctor removes the tiny needles, a dry sterile dressing is applied and you are monitored briefly.

What can I expect after the hypogastric block?

If the block is successful, you will begin to feel significant improvement in pain within a few minutes or hours after the injection. The procedure is either diagnostic or therapeutic. With the diagnostic block, the injection is done to test your response to blocking the superior hypogastric plexus. The therapeutic block is done to destroy the nerves and offer long-term pain relief.

What are the benefits of the superior hypogastric plexus block?

The procedure is safe, effective, and only takes a few minutes to perform. It can be used to treat many types of pelvic and visceral pain. Also, the block treats offers immediate relief. Because many structures are innervated by the superior hypogastric plexus, one injection can treat several areas at once.

What are the risks associated with the hypogastric block?

As with any minimally invasive procedure, there are a few risks associated with the superior hypogastric plexus block. These include hematoma (blood accumulation), bleeding, infection, and nerve damage.

Does the hypogastric block work?

There are several studies that support the effectiveness of the superior hypogastric plexus block. In 1990, researchers found that the block was useful for patients with pelvic pain associated with cancer, with 70% of patients noting a significant decrease in pain levels following the procedure.

In addition, research shows that people do not need as much pain medication following a hypogastric block. For men, the procedure is proven to help with both prostate and penile pain.

Resources

De Leon-Casasola OA, Kent E, Lema MJ – Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain, 1993;54:145-151. 

Plancarte R, Amescua C, Patt RB et al – Superior hypogastric plexus for pelvic cancer pain. Anesthesiology, 1990;73: 236-239.  

Wechsler RJ, Maurer PM, Halpern EJ et al – Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology, 1995;196:103-106.