FAQ’s on Superior Hypogastric Plexus Block in Philadelphia

A superior hypogastric block is an advanced procedure used to treat genital and pelvic pain that does not respond to conventional measures and medications. This injection targets the superior hypogastric plexus, which is a bundle of nerves that supply the visceral and pelvic regions.

What conditions are treated with the superior hypogastric plexus block?

This block is used to treat:

  • Cancer pain
  • Chronic pelvic pain
  • Endometriosis
  • Prostatitis
  • Myofascial pain syndrome
  • Interstitial cystitis
  • Pelvic inflammatory disease
  • Dysmenorrhea (painful periods)
  • Cystitis
  • Pelvic congestion
  • Varicocele
  • Painful pelvic fibrosis
  • Radiation-induced neuropathy
  • Pelvis neurodystonica

What is the superior hypogastric plexus?

The superior hypogastric plexus is a collection of nerves, which lie in the space directly in front of the fifth lumbar and first sacral disc. This bundle contains both efferent and afferent fibers from the sympathetic nervous system. The structures supplied by the superior hypogastric plexus include the bladder, vagina, urethra, vulva, prostate, uterus, ureters, perineum, penis, ovaries, testicles, and lower colon/rectum.

How do I prepare for the superior hypogastric plexus block?

Before the procedure, notify the doctor of any medications you are taking. Blood-thinning agents must be held for 3-7 days before the block. You should arrange to have someone drive you home. When you come to the medical center, a nurse will review the procedure risks and benefits, and have you sign a consent form. Be sure to notify the doctor of any blood-thinning agents you are taking. Afterwards, you change into a gown, and the nurse places an IV catheter in your arm to administer sedatives and other medications/fluids.

How is the superior hypogastric plexus block done?

This procedure is done in the outpatient setting under local anesthesia. The doctor will provide IV sedation to make you comfortable. The procedure most often used is the posterior approach, where the needle is inserted through the back using fluoroscopy or ultrasound guidance. The skin over the lower back is cleansed with an antiseptic, and a local anesthetic is used to numb the area. Two small needles are inserted and guided over the nerve bundle. A small amount of contrast dye is injected to verify placement. The doctor injects a local anesthetic, and possible a neurolytic agent onto the nerves.

What happens after the superior hypogastric plexus block procedure?

After the procedure, a nurse will monitor you for 20-30 minutes. Temporary soreness at the injection site is expected, and you may experience lightheadedness, numbness of the pelvic region and lower extremities, as well as nausea. These side effects usually resolve within a few minutes. You should rest for the remainder of the day, and avoid soaking in a tub of water or pool for 2-3 days. Return to normal activities as tolerated. A nurse will give you detailed instructions when you leave the outpatient center.

What risks are associated with the superior hypogastric plexus block?

This block is a safe procedure with a very low risk profile. However, complications could occur, such as infection, bleeding, nerve damage, and blood vessel injury.

Does the superior hypogastric plexus block work?

Our pain management specialist prefer this interventional procedure for treating many types of pelvic pain. In one study, the efficacy rate was reported at 70%, with a significant decrease in need for pain medication. Another study showed a 72% success rate with superior hypogastric neurolysis.

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.