Hypogastric Plexus Block
Introduction
The hypogastric plexus is a collection of nerves located just in front of the fifth lumbar and first sacral vertebrae, or in the lower part of the abdomen in the upper front of the pelvis. The nerves that make up this plexus are a part of the sympathetic nerve system, which control many of the body’s actions that are performed without our conscious knowledge. In the case of the nerves of the hypogastric plexus, they control the organs of the pelvic region, including the bladder, lower intestine, the uterus, ovaries and vagina in women and the testicles and prostate in men.
What Can go Wrong?
Usually, sympathetic nerves do not send pain signals to the brain, but in certain conditions these signals can be ‘switched on.’ There is any number of severe conditions in the pelvic region that can be directly related to the organs that are controlled by the hypogastric plexus, including chronic pancreatitis, problems in the bladder or lower intestine, or cancer in any of the organs of the pelvic region. The pain can be unrelenting and in most cases, traditional oral pain killers, both those that are available over the counter and those strong enough to only be available through prescription will not relieve the pain. In these cases, a hypogastric plexus block can not only help diagnose the cause of the pain but help relieve the pain as well.
The Procedure
A hypogastric plexus block is typically performed on an out-patient basis and most of the patients that have this procedure done will be able to go home the same day. First, the patient will be given an IV and administered a mild sedative to help him relax. The IV will stay in during the procedure in case the doctor needs to administer other fluids. The procedure is carried out with the patient lying on his stomach.
Physicians will use x-ray guidance called fluoroscopy to guide the needle to the appropriate area for the injection. Once the skin is cleaned, a local anaesthetic is administered and an injection made on either side of the lower spine near the hip bones. A solution of local anaesthetic which is often accompanied by a steroid are injected near the hypogastric plexus, which blocks pain signals from being sent to the brain. The whole procedure usually lasts less than twenty minutes.
Patients should feel relief from the pain within fifteen minutes to half an hour after the procedure. Most patients will be kept for observation for an hour after the procedure and may feel discomfort at the injection sites in the back for a day or two. They should have someone drive them home and they should not operate machinery for twenty-four hours after the procedure.
