Hypogastric plexus block and neurolysis

Abstract

The treatment of lower abdominal and pelvic visceral pain can be challenging for the pain management practitioner. Prior to 1990, treatment consisted of medication and sometimes highly invasive neurosurgical procedures. Plancarte and colleagues first reported the successful treatment of malignant pelvic pain in 1990 with blockade of the superior hypogastric plexus. The superior hypogastric plexus is a retroperitoneal structure located near the bifurcation of the abdominal aorta and contains visceral, sympathetic, and parasympathetic efferents as well as parasympathetic and visceral afferents to pelvic structures. Indications are benign and malignant pain of the lower abdominal and pelvic visceral organs. Appropriate pre-procedure planning should include review of radiological films and concurrent medication to increase efficacy and decrease the incidence of complications. Different approaches to the superior hypogastric plexus block have been described and the choice of technique depends on anatomy and the practitioner’s experience with minimally invasive procedures. Blockade of the inferior hypogastric plexus has also been described. Analgesia and reduction of opiate dosage have been reported in the literature.