The superior hypogastric plexus block is used to provide pain relief to body areas and organs innervated by the superior hypogastric plexus nerves. The plexus is a nerve bundle located near the sacrum and lower spine. It supplies sensation to the pelvis and lower abdominal organs and structures.
The block is used to treat patients who have disorders, cancers, and complications of their uterus, bladder, prostate, and intestines. In addition, the block is used for chronic pancreatitis, chronic pelvic pain, prostate cancer pain, and functional abdominal pain.
The procedure only takes 15 minutes, but you should plan to be at the medical center for 1-2 hours.
Because a local anesthetic is used to numb the skin before the injection, you will feel a pinch and slight burning sensation. When the injection is done, most patients only report feeling pressure. However, some may feel mild discomfort. After the procedure, soreness of the injection site is common, and this may persist for a few days.
Before the hypogastric plexus block procedure, you should not eat or drink for 6 hours. However, you are permitted to take necessary medications with small sips of water. If you are taking blood-thinning drugs, such as Coumadin or Plavix, discuss this with your doctor, as these medicines must be held for several days. Arrange for someone to drive you home after the procedure, as it is an outpatient procedure. When you arrive at the medical center, a nurse will discuss the risks and benefits of the block. You must sign a form implying you have been informed of the procedure. After you change into a gown, the nurse will place an IV catheter in your arm and connect you to the blood pressure, heart rate, and oxygen monitor.
You will be positioned face-down on the procedure table and given an IV sedative. The doctor will numb the skin with a long-acting anesthetic and use fluoroscopy (real-time x-ray) to insert special needles near the nerve cluster. Depending on the doctor’s choice, a long-acting anesthetic is administered to the nerves. For long-lasting blocking, a neurolytic agent may be used (phenol or absolute alcohol).
After bandages are applied to the injection sites, you will remain in the recovery area for 20-30 minutes. A nurse will assess your vital signs, and the doctor will ask you questions regarding your pain. You should not drive for 24 hours, and should avoid heavy activity for a few days. You may return gradually to regular activities as tolerated.
The overall success rate varies from 50-90%, based on research reports. In a recent clinical study of 32 patients, 53% reported a positive outcome. The success rate for patients with bladder cancer has been reported at 89%. Pain relief was noted by a decrease in opioid use as well as improved functional status.
As with other outpatient procedures, there are a few risks to consider. These include swelling at the injection site, bleeding, infection, nerve injury, and allergic reaction. Side effects to sedatives include drowsiness, confusion, dry mouth, and dizziness.