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Sympathetic Plexus Block - Hypogastric

What is a hypogastric plexus block?

The hypogastric plexus is a collection of nerves that is located in front of the fifth lumbar and first sacral vertebral bodies. This means that the plexus is located near the lower part of your abdomen in the upper front of your pelvis. A hypogastric plexus block involves the administration of a dose of pain killing medication near the region of this nerve collection. The hypogastric block usually involves a series of several injections, repeated at weekly or bi-weekly intervals. This treatment has brought relief to many patients who suffer from pain located in the pelvic structures, to include pain located in the region of the bladder, lower intestines, as well as the uterus, ovaries and in women, and the prostate and testicles in men. 

How quickly can I expect pain relief?

Most patients can expect pain relief within the first 15 to 20 minutes after the injection of local anesthetic. This pain relief may only last several hours; however, if the physician has also used steroid medication, you may also receive some pain relief that will begin roughly 36 hours after the injection. Duration of pain relief is somewhat variable, as it differs from patient to patient. 

How should I prepare for the procedure?

The hypogastric plexus block is a safe medical procedure; but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

  • Do not eat or drink anything for (6) six hours prior to the procedure.
  • Plan on spending roughly one to two hours at the surgery center.  This allows for time for registration, preparation, performance of the procedure and observation after the procedure.
  • Some patients choose to have conscious sedation which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.  If you choose to have sedation of any kind, you are required to have a responsible adult driver accompany you to the procedure.  If you feel that you require sedation, please discuss it with your physician.
  • If you are allergic to specific local anesthetics or ionic contrast, please notify your physician. Also, if you are taking any blood thinners (Coumadin, Plavix, Warfarin, Lovenox, Aspirin, etc,) please let your physician know ahead of time to help devise a safe plan for the injection. 

What happens during the procedure?

You will be placed in the prone position (on your stomach) on the fluoroscopy table in the procedure room. The physicians will then use x-ray guidance to aid in appropriate placement of the medication. After clearing a small patch of your skin, a local anesthetic is injected into the skin to decrease any pain associated with performance of the procedure. The medication will then be administered through a needle near your hip bones on both sides. The procedure itself usually lasts 10 to 15 minutes. Occasionally, patients describe a very transient recurrence of their pelvic pain during administration of their medication. This is viewed as a reassuring sign that the medication is going to the right place, and the sensation usually disappears very quickly.

What happens afterwards?

After the hypogastric plexus block is performed, we will continue to monitor you in the recovery room for 15 to 30 minutes where you will be offered a drink and a snack. If there are no signs of any problems, you will be ready to leave.

What should I expect from this procedure?

Expect the block to provide you with several hours of pain relief. After this time, the pain will likely return. If the physician has used steroid medication in addition to the local anesthetic, this may provide you with further pain relief after 36 to 48 hours. Sometimes, this block is performed for diagnostic reasons. This means that your physicians have chosen to do this block in order to determine a possible cause for your pain. In this instance, you may or may not experience any pain relief. 

What possible side effects might I see?

The most common side effect from this procedure is a sore back in the region where the blocks were performed. There is a very small chance of the needle puncturing a blood vessel. This potentially could lead to blood clot formation in your pelvis; however, this is extremely rare and your physician will take extra precautions to attempt to avoid this complication. There is also a very rare chance of injury to either the kidney or urethras. The urethras are the structure that connects your kidneys to your bladder. These risks are, again, extremely small and are even less likely when the procedure is performed under x-ray guidance.

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