FAQs on Superior Hypogastric Plexus Block

A superior hypogastric block is used to treat pelvic and genital pain that is not responsive to conventional medications and treatments. This block targets the superior hypogastric plexus, which is a nerve bundle that supplies the pelvic and lower abdominal regions.

What conditions benefit from the superior hypogastric plexus block?

  • Chronic pelvic pain – Related to adhesions, fibroids, or other conditions.
  • Cancer pain – Related to pelvic and abdominal organs and structures.
  • Prostatitis – Chronic inflammation of the prostate gland.
  • Endometriosis – Tissue growing outside the uterine cavity.
  • Interstitial cystitis – Painful disease of the bladder.
  • Myofascial pain syndrome – Painful muscle covering over the organs.
  • Dysmenorrhea – Painful periods.
  • Pelvic inflammatory disease – Occurs related to sexually transmitted infections (STIs).
  • Pelvic congestion – Swelling of the pelvis area.
  • Cystitis – Bladder infections.
  • Pelvic fibrosis – Painful fibers in the pelvis.
  • Varicocele – Blood vessel mass of the testicle region.
  • Radiation-induced neuropathy – Nerve damage due to radiation therapy.
  • Pelvis neurodystonia – Loss of tone to the pelvic structures.

What is the purpose of the superior hypogastric plexus?

The superior hypogastric plexus is a bundle of nerves that lie in the space in front of the fifth lumbar (low back) spinal disc and the first sacral (very low back) intervertebral disc. This nerve mass is part of the sympathetic nervous system. The body structures supplied by these nerves include vagina, bladder, vulva, urethra, prostate, uterus, perineum, ureters, ovaries, penis, lower colon, rectum, and testicles.

What can I expect before the block?

The doctor will need to know which medications you are on, as certain blood-thinning agents are to be held for several days before the procedure. Notify the doctor of all medical conditions, and arrange to have someone drive you home. You should not eat or drink six hours before the procedure, but take necessary medications with small sips of water. When you come to the center, a nurse has you sign form of informed consent after going over the procedure risks and benefits. After you change into a gown, the nurse places an intravenous line in your arm.

How is this block done?

The superior hypogastric plexus block is done using IV sedation with the patient positioned on his/her stomach. The back region is cleaned with an antiseptic, and the skin and deeper tissues are numbed using lidocaine. Using x-ray guidance, a special needle is positioned near the nerve bundle, and the anesthetic, corticosteroid, and/or neurolytic agent is injected onto the nerves. After removing the needle, a dry bandage is placed over the injection site.

What can I expect after the superior hypogastric plexus block procedure?

A nurse will monitor your condition for around 30 minutes. Expect some soreness at the injection site, as well as numbness of the pelvis and lower extremities. These side effects resolve within a few minutes. We recommend that you rest the remainder of the day, avoid soaking in a tub, and gradually return to usual activities.

Is the superior hypogastric plexus block effective?

According to a recent clinical study, the success rate of the superior plexus block is about 70%. Most study participants had a great decrease in the need for pain medicine following the block. In another study where neurolysis was done, the efficacy rate was 72%.

What risks are associated with the superior hypogastric plexus block?

According to experts, this procedure is safe and effective. However, as with other minimally invasive procedures, some rare risks must be considered. These include bleeding, infection, blood vessel damage, and nerve damage.

Resources

Gamal G, Helaly M, Labib YM: Superior hypogastric block. transdiscal versus classic posterior approach in pelvic cancer pain Clin J Pain. 2006; 22:544-547.

Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008; 36:732-5.

Schmidt AP, Schmidt SR, Ribeiro SM. Is superior hypogastric plexus block effective for treatment of chronic pelvic pain? Rev Bras Anestesiol. 2005;55(6):669-679.