Blockade of the Superior Hypogastric Plexus Block for Visceral Pelvic Pain

Abstract

Visceral pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain independent of its etiology. Five major pathways by which pelvic pain is transmitted can be identified. One of them, the superior hypogastric plexus, an extension of the preaortic plexus, is easily assessable to blockade by local anesthetics and neurolytic agents. Several techniques have been described. Long-lasting pain relief with this procedure has been achieved in patients with pelvic cancer pain. However, there is a discrepancy between diagnostic and therapeutic blockade in patients with nonmalignant pain. Because a diagnostic blockade can give significant pain relief in a large variety of patients, it is worthwhile to investigate new methods that provide lasting neural blockade of the superior hypogastric plexus and long-lasting relief of this devastating condition.

Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus

“…Success rates for IHP nerve blockade may be increased by positioning the needle tip closer to the midline point using a more horizontal angle of approach as it is advanced anteromedially through the foramina. Performing a bilateral procedure in those cases where the midline cannot be reached with the needle tip, or increasing the volume of therapeutic agent injected also would increase the success rates for analgesia with this technique [9,10].…”

Laparoscopic management of neural pelvic pain in women secondary to pelvic surgery

“…However, to try to surgically find pelvic neuromas in the IHP even by laparoscopy is utopic; destruction of this plexus is not viable, as it is involved in the important pelvic visceral reflexes (12), and blockade of all afferent pathways is also very difficult as there are five major autonomic pathways that can transmit nociceptive information (13). Information may also not necessarily follow just one pathway and high stimuli may result in the activation of neighboring unmyelinated fibers originating from a different site so that a blockade of just one particular pathway is mostly unlikely to provide complete pain relief.…”

Interventional Modalities for Chronic Pain Management

“…However, some authors have recommend percutaneous sympatholysis for long term effects, in case non-destructive local anaesthetic blocks are effective. Superior hypogastric neurolysis is also recommended by some authors for pelvic pain syndromes 82 .…”