Superior hypogastric plexus block

Understanding your diagnosis

Pain from the pelvic organs, the uterus, ovaries, cervix, bladder, prostate, seminal vesicles, testicles, rectum, and lower colon, travels through sympathetic fibers that gather into a flat nerve network lying in front of the lowest lumbar vertebra, just below where the main abdominal artery divides. That network is the superior hypogastric plexus. Because these signals converge before entering the spinal cord, pelvic visceral pain is characteristically deep, diffuse, difficult to point to, and frequently unresponsive to treatment aimed at the pelvic floor, the hip, or the lumbar spine.

The treatment

Medication is placed directly onto this plexus, interrupting pain signals from the pelvic organs. A diagnostic block with local anesthetic is performed first: relief confirms your pain is traveling this sympathetic pathway rather than arising from muscle, joint, or somatic nerve. For cancer-related pelvic pain or confirmed durable benefit, neurolysis with alcohol or phenol provides relief lasting months.

Important: this block targets sympathetic fibers only. It does not affect the nerves controlling leg strength, bowel continence, bladder continence, or sexual function.

Before your procedure

Fasting, sedation, and your ride home

• If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
• We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
• Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.

Where to go

Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.

Procedure day

• Performed under live X-ray (fluoroscopy) for precision.
• Contrast dye confirms placement and excludes vascular injection before medication is given.
• Local numbing medication with IV sedation for comfort.
• The procedure takes approximately 30 minutes.
• You will walk out and go home the same day.

Afterward: what to expect

• The flare. Localized low back soreness for 2 to 5 days is expected. Ice 20 minutes on, 20 off; continue your baseline medications.
• The anesthetic window counts. Relief lasting only hours after a diagnostic block is still a positive result. Record how long it lasted and roughly what percent it helped; that determines whether we proceed to neurolysis.
• Steroid results. If steroid was included, peak effect develops over 3 to 7 days.
• Neurolytic results. Relief builds over 1 to 3 days and is formally assessed at 2 weeks.
• What this block does not do. It does not weaken your legs and does not affect bowel, bladder, or sexual function. Any such symptom is a red flag, not an expected effect.
• Blood glucose. If a steroid was included, expect a temporary rise in blood glucose that usually resolves within a few days. Diabetic patients should monitor their sugar levels closely for 48 to 72 hours after the procedure.

Follow-up schedule

1. 1

   1 to 2 weeks

   Assessment of degree and duration of relief; decision on neurolysis or repeat. Keep a simple record of percent improvement and days of relief, and bring an updated medication list; opioid doses are frequently reduced at this visit.

Call us right away if you notice

This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.