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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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When the superior hypogastric plexus block is used diagnostically for patients with pelvic pain syndromes, it is always advisable to emphasize that the block is being performed for diagnostic purposes and that no neurolytic block is planned. To use the block most effectively, the anesthesiologist must become comfortable with the anatomy, both bony and neurovascular. This block is not possible in my hands without fluoroscopy; thus, another strong recommendation is to develop competence with fluoroscopic needle placement for this block. The technique of lining up the needle path with the fluoroscopic beam is a radiographic guidance technique that appears to simplify needle placement.

Some cancer patients who may be candidates for neurolysis have previously undergone extensive pelvic surgery, perhaps combined with radiation therapy of the pelvis. In these patients extra time should be spent to ensure that the pattern of radiocontrast spread appears typical. This recommendation stems from experience with patients in whom extensive prior surgery and radiotherapy has altered the typical neurovascular anatomy. As with celiac neurolysis, complete pain relief following this block is not frequent, but the block often increases patient comfort and minimizes the need for opioid therapy, which often improves the patient’s quality of life during the remaining months of life.

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