Superior Hypogastric Plexus Block

The superior hypogastric block has just been recently been introduced for the treatment of pelvic pain, either to nonmalignant or malignant pain. The technique was first described by Ricardo Plancarte in 1989. The plexus lies anterior to the body of the L5 vertebra. It contains postganglionic sympathetic fibers and afferent pain fibers. Innervation of the vagina, rectum, bladder, perineum, vulva, prostate, and uterus arise from this plexus. Therefore, pain felt to originate from any of these structures could theoretically be treated by blockade of this plexus. The block is performed under CT and fluoroscopic guidance, with the needles placed anterior to the L5-S1 junction. The proximity of the iliac crests necessitates a fairly lateral and slightly cephalad approach. It has been used successfully in the treatment of pelvic pain, and is indicated after oral regimens have failed.

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