What is this Type of Block?
A superior hypogastric plexus block is a kind of injection used to manage pain from the region of the pelvic that is not being managed adequately by oral medications. This type of block can also be indicated if the side effects for a pain relieving medication (excess nausea, constipation, and sedation) are not tolerable to the patient.
Since the “superior hypogastric plexus” encloses efferent sympathetic fibers to and afferent pain fibers from the urethra, uterus, vagina, vulva, bladder, perineum, penis, prostate, rectum, testes and descending colon, this block can possibly get rid of pain that begins from the above named regions. The most recent literature shows that the block has been effective in treating both malignancy-related anal-rectal pain and nonmalignant penile pain which further adds validation for the use of this block.
Used on pain beginning from the urethra; bladder; uterus; vulva; vagina; perineum; penis; prostate; testes; rectum; and descending colon or pain that is secondary to: endometriosis, metastasized cancer to the pelvis (cervical, testicular, prostate, testicular, colorectal etc.); and radiation injury.
What is the Anatomy of this Area?
The “superior hypogastric plexus” is a retroperitoneal configuration that lengthens bilaterally, just anterior to the vertebral column and between the lower third of L5 and upper third of S1 vertebral bodies. It is formed by efferent sympathetic nerves and pelvis visceral afferents from branches of the aortic plexus and fibers from the splanchnic nerves.
Its location allows it to innervate the majority of pelvis viscera (including the urethra, vagina, bladder, perineum, prostate, vulva, penis, rectum, testes, and descending colon).
Description of this Block
This type of block is normally done with a posterior approach (through the back). If you can lie down on your abdomen, face down without any large agony your Las Vegas Pain Doctor will most likely use this method. If you are not able to lie down in this position, this position causes you too much pain, your LV pain doctor deems it to technically difficult based on your anatomy of your lower spine, he or she might choose the anterior method or the transdiscal method.
The anterior method might be done with fluoroscopy, computed tomography-guidance or guidance by ultrasound and it lets you lay down on your abdomen or your side. Using this technique, your physician progresses the needle through the skin and muscle of your back and L5-S1 intervertebral disc to reach the “superior hypogastric plexus”. But, the posterior method remains one of the more common methods to performing this block and is also done under fluoroscopy or computed tomography-guidance. Fluoroscopy tends to be the imaging technique favored since there is less radiation exposure to the patient.
You will be asked to lie down on your stomach with a pillow under the pelvis to help flatten out the natural curvature in the lower lumbar spines. Your lower back will then be prepped and draped in a sterile manner prior to local anesthesia being administrated at the two points of entry of the needle into the skin. When your skin is sufficiently anesthetized, 2 needles will be advanced under control of the fluoroscope until placement of the needle is correctly obtained. Their correct placement will also be established by administration of contrast dye. Once there is validation of the position either a diagnostic block or a therapeutic block will be done.
How to know if this Block is a Success
A successful block is marked by pain relief that is profound. Local anesthetic usually directed for “superior hypogastric plexus” diagnostic block or for those patients with non-cancer related pain. For those with a known response to management of local anesthetic onto the “superior hypogastric plexus,” a therapeutic block is done with management of the neurolytic agent such as phenol. Radiofrequency ablation of the “superior hypogastric plexus” is also another treatment modality for longer-lasting pain relief.
The procedure usually takes less than 15 minutes. Often your Vegas pain doctor will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure.
The Nevada Pain Network connects those having pelvic pain with pain management doctors Las Vegas trusts. The treatments may include pain medication management, or interventional procedures such as superior hypogastric plexus blocks. If you or a loved one is experiencing pelvic pain, let the Network help you with Board Certified, Award Winning pain clinics in Las Vegas such as Innovative Pain Care Center.
Call (702) 323-0553 for more information and scheduling.