Most of the pain the pelvic area is mediated by the superior hypogastric plexus. The superior
hypogastric block has just been recently been introduced for the treatment of pelvic pain, either to
nonmalignant or malignant pain. The plexus lies anterior to the body of the L3 to L5 vertebra. It
contains postganglionic sympathetic fibers and afferent pain fibers. Innervation of the vagina,
rectum, bladder, perineum, vulva, prostate, testes, and uterus arise from this plexus. Therefore,
pain felt to originate from any of these structures could theoretically be treated by blockade of this
plexus. The block is performed under CT and fluoroscopic guidance, with the needles placed
anterior to the L5-S1 junction.
After an IV is placed in the preop area, the patient will be placed in the prone position. Using a live
X-ray the position the plexus in the lower back will be identified, and the skin over that area will be
numbed by local anesthetics. Under fluoroscopic guidance a needle will be directed to the desired
position. Prior to injecting the local anesthetic solution, the correct position of the needle will be
confirmed using contrast solution.
The procedure lasts about 20-30 minutes. After the completion of the procedure, Band-Aids will
be placed at the injection sites, and a nurse will monitor the blood pressure and pulse and will
review the discharge instructions with the patient before going home.
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