Superior Hypogastric Block
The superior hypogastric plexus is an extension of the aortic plexus in the retroperitoneal place below the aortic bifurcation. It is situated anterior to the L5-S1 disk space. It contains almost exclusively sympathetic fibers. Superior hypogastric block may be useful in patients with gynecologic disorders in whom pain may or may not be dependent on the menstrual cycle. The most common causes of pain in these patients are endometriosis, adhesions, and chronic inflammation. Other patients who may benefit from this procedure are those with interstitial cystitis, irritable bowel syndrome and/or chronic pain after a surgical procedure such as supra-public prostatectomy.
Superior hypogastric block is done under fluoroscopy with the patient in a prone position. The success for an ablative procedure is approximately 50% pain reduction and 40% reduction in opiate medication lasting at least 3 weeks. So overall there is approximately 50% success. This is, however, still encouraging since these are end-stage pain patients in whom nothing else has been helpful.
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