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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 43 – Superior Hypogastric Plexus Block

PERSPECTIVE

The superior hypogastric plexus block is conceptually patterned after the use of neurolysis of paravertebral neural plexuses to provide intra-abdominal or lower extremity pain relief. Gynecologic surgeons have performed presacral neurectomy for years to treat a variety of pelvic pain syndromes, but this surgical procedure was really designed to interrupt the superior hypogastric plexus. The superior hypogastric plexus block is used for both diagnostic and therapeutic purposes in patients with both benign and cancer pain syndromes. Nevertheless, much of the focus remains on neurolysis to provide pain relief for patients with pelvic cancer pain syndromes who are otherwise difficult to treat.

Patient Selection.

When superior hypogastric plexus block is used diagnostically in patients with chronic benign pelvic pain syndromes, it affords a better definition of the source of the pain. It is less frequently used for this purpose than for neurolysis of the plexus to produce long-lasting pain relief in patients with pelvic cancer. Cancer pain syndromes that may be amenable to pain relief with a superior hypogastric plexus block include cervical, proximal vaginal, uterine, ovarian, testicular, prostatic, and rectal cancers. The technique has also been used to relieve pain in patients with distal colonic or rectal inflammatory bowel disease.

Pharmacologic Choice.

During diagnostic blocks, the choice of local anesthetic is determined by the length of the block desired. Often this means that 0.25% bupivacaine or 0.2% ropivacaine with 1: 200,000 epinephrine is used through bilaterally placed needles to a total dose of 20 to 30 mL. Shorter-acting local anesthetics such as 1% lidocaine, again often with 1: 200,000 epinephrine, are also effective. When neurolysis is the goal, a radiocontrast agent, 2 to 4 mL through each needle, is used to ensure the correct needle position; then 8 to 10 mL of 10% aqueous phenol or 50% alcohol can be used as the neurolytic agent.

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