Superior hypogastric plexus block is the common treatment for tailbone or pelvic pain. The superior hypogastric plexus is a retroperitoneal structure located bilaterally at the level of the lower 3rd of the fifth lumbar and upper third of the first sacral promontory and in proximity to the bifurcation of the common iliac vessel. This plexus is formed by the visceral afferent nerves and the sympathetic nerves from the aortic plexus. The organs innervated by the superior hypogastric plexus include the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testis, rectum and descending colon. During the growth of malignancies and degenerative conditions of any of these visceral organs can cause severe progressively enervating pain and often recommended if patients have taken pain relievers that were ineffective or caused unbearable side effects. In such cases, this technique is helpful by preventing pain signals reaching the plexus.
Indication
The superior hypogastric plexus block is indicated for chronic intractable lower abdominal or pelvic pain. Indications include:
- Non-malignant pelvic pain
- Endometriosis
- Proctalgia
- Testicular pain
- Ilioinguinal neuralgia or post herniorrhaphy pain
- Neoplastic pelvic pain
Before treatment
Prior to the hypogastric pain treatment procedure, the area where the needle is inserted will be numbed with local anesthetic and prepped with an antiseptic solution such as Povidone iodine or chlorhexidine. The surrounding areas of the injection site will be draped with surgical linen for sterile field. When performing a superior hypogastric plexus block, the physician will use an X-ray or a fluoroscope as a guide to insert the needle and catheter before the anesthetic is administered.
Superior Hypogastric Plexus Block Procedure
This procedure is a nerve block and can be done in an outpatient procedure room or X-ray table under local anesthesia. The most common approach are the posterior and transdiscal approaches. In the posterior approach, the patient is placed in the prone position with one or two pillow under the lower abdomen to reduce lumbar lordosis. And if this approach is stressful to the patient or not feasible with the physician due to technical difficulties then the transdiscal or anterior technique is used with fluoroscopy or ultrasound guidance. A contrast dye wil be used to confirm the placement of the needles. Once the needles are placed, either a diagnostic block to determine whether the pain originates from that site or therapeutic block to offer pain relief and pain will be relieved significantly.
Results
This treatment is a well established procedure for the treatment of chronic pelvic pain particularly related secondary to malignancies. It is minimally invasive and does not require surgery. It involves injecting either an anesthetic or a substance that destroys nerve tissue to reduce pain. Some patients have reported that their pain was completely alleviated and did not return even at a two year follow-up. Others have been able to take a lower dose of medication or stop taking it altogether.
