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Superior and Inferior Hypogastric Blocks
Daewoong Lee, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Definitions

              • Superior hypogastric plexus is midline, retroperitoneal structure situated bilaterally on L5 vertebral body, anterior to bifurcation of abdominal aorta; plexus receives contributions from L3-L4 splanchnic nerves and pelvic splanchnic nerves (S2-S4) that ascend from inferior hypogastric plexus
                • It divides into right and left hypogastric nerves, which course lateral to sigmoid colon and rectosigmoid junction and medial to internal iliac artery, to join 2 inferior hypogastric plexuses
                • Plexus sends out multiple branches to supply sympathetic innervation to all pelvic viscera except ovaries and fallopian tubes
              • Inferior hypogastric plexus is bilateral structure on either side of rectum and lower part of bladder
                • It consists of both hypogastric nerves, which continue from superior hypogastric plexus, sacral splanchnic nerves, and pelvic splanchnic nerves (S2-S4)
                • While superior hypogastric plexus is in predominantly longitudinal plane, inferior counterpart is in transverse plane, extending posteroanteriorly and parallel to pelvic floor

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Patient Position/Location

                      • Equipment Preparation

                        • Procedure Steps

                          POST PROCEDURE

                          • Things To Do

                            OUTCOMES

                            • Complications

                              Selected References

                              1. Choi JW et al: The optimal approach for a superior hypogastric plexus block. Pain Pract. 18(3):314-21, 2018
                              2. Nagpal AS et al: Interventional management for pelvic pain. Phys Med Rehabil Clin N Am. 28(3):621-46, 2017
                              3. Stogicza A. Superior and inferior hypogastric plexus blocks, In Diwan, S et al Atlas of pain medicine procedures. New York: McGraw-Hill Education/Medical, 2015
                              4. Choi HS et al: A new technique for inferior hypogastric plexus block: a coccygeal transverse approach -a case report-. Korean J Pain. 25(1):38-42, 2012
                              5. Stogicza. A et al: Inferior hypogastric plexus block affects sacral nerves and the superior hypogastric plexus. https://www.hindawi.com/journals/isrn/2012/686082/. Published 2012. Reviewed July 31, 2019. Accessed July 31, 2019.
                              6. Petersohn J: 42 – Sympathetic neural blockade. https://www.sciencedirect.com/science/article/pii/B9781416037798100429?via%3Dihub#s0010. Published 2011. Reviewed July 31, 2019. Accessed July 31, 2019.
                              7. Rohen, JW et al: Color atlas of anatomy: a photographic study of the human body. Stuttgart New York Philadelphia: Schattauer Lippincott Williams & Wilkins. 346, 2006
                              8. Schultz DM: Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 10(6):757-63, 2007
                              9. Gamal G et al: Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 22(6):544-7, 2006
                              10. Turker G et al: A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 206(3):277-81, 2005
                              11. Rosenberg SK et al: Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med. 23(6):618-20, 1998
                              12. Plancarte R et al: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 22(6):562-8, 1997
                              13. Plancarte R et al: Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 73(2):236-9, 1990
                              14. Curry SL et al: Malignant teratoma of the ovary: prognostic factors and treatment. Am J Obstet Gynecol. 131(8):845-9, 1978
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Procedure

                                    • Post Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Definitions

                                          • Superior hypogastric plexus is midline, retroperitoneal structure situated bilaterally on L5 vertebral body, anterior to bifurcation of abdominal aorta; plexus receives contributions from L3-L4 splanchnic nerves and pelvic splanchnic nerves (S2-S4) that ascend from inferior hypogastric plexus
                                            • It divides into right and left hypogastric nerves, which course lateral to sigmoid colon and rectosigmoid junction and medial to internal iliac artery, to join 2 inferior hypogastric plexuses
                                            • Plexus sends out multiple branches to supply sympathetic innervation to all pelvic viscera except ovaries and fallopian tubes
                                          • Inferior hypogastric plexus is bilateral structure on either side of rectum and lower part of bladder
                                            • It consists of both hypogastric nerves, which continue from superior hypogastric plexus, sacral splanchnic nerves, and pelvic splanchnic nerves (S2-S4)
                                            • While superior hypogastric plexus is in predominantly longitudinal plane, inferior counterpart is in transverse plane, extending posteroanteriorly and parallel to pelvic floor

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Patient Position/Location

                                                  • Equipment Preparation

                                                    • Procedure Steps

                                                      POST PROCEDURE

                                                      • Things To Do

                                                        OUTCOMES

                                                        • Complications

                                                          Selected References

                                                          1. Choi JW et al: The optimal approach for a superior hypogastric plexus block. Pain Pract. 18(3):314-21, 2018
                                                          2. Nagpal AS et al: Interventional management for pelvic pain. Phys Med Rehabil Clin N Am. 28(3):621-46, 2017
                                                          3. Stogicza A. Superior and inferior hypogastric plexus blocks, In Diwan, S et al Atlas of pain medicine procedures. New York: McGraw-Hill Education/Medical, 2015
                                                          4. Choi HS et al: A new technique for inferior hypogastric plexus block: a coccygeal transverse approach -a case report-. Korean J Pain. 25(1):38-42, 2012
                                                          5. Stogicza. A et al: Inferior hypogastric plexus block affects sacral nerves and the superior hypogastric plexus. https://www.hindawi.com/journals/isrn/2012/686082/. Published 2012. Reviewed July 31, 2019. Accessed July 31, 2019.
                                                          6. Petersohn J: 42 – Sympathetic neural blockade. https://www.sciencedirect.com/science/article/pii/B9781416037798100429?via%3Dihub#s0010. Published 2011. Reviewed July 31, 2019. Accessed July 31, 2019.
                                                          7. Rohen, JW et al: Color atlas of anatomy: a photographic study of the human body. Stuttgart New York Philadelphia: Schattauer Lippincott Williams & Wilkins. 346, 2006
                                                          8. Schultz DM: Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 10(6):757-63, 2007
                                                          9. Gamal G et al: Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 22(6):544-7, 2006
                                                          10. Turker G et al: A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 206(3):277-81, 2005
                                                          11. Rosenberg SK et al: Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med. 23(6):618-20, 1998
                                                          12. Plancarte R et al: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 22(6):562-8, 1997
                                                          13. Plancarte R et al: Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 73(2):236-9, 1990
                                                          14. Curry SL et al: Malignant teratoma of the ovary: prognostic factors and treatment. Am J Obstet Gynecol. 131(8):845-9, 1978