Superior Hypogastric Plexus Block

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OVERVIEW PURPOSE RISKS PREPARATION DURING THE TEST AFTER THE TEST NEXT STEPS

What is a superior hypogastric plexus block?

A superior hypogastric plexus block (SHPB) is a type of shot (injection). It’s used to diagnose and treat pain in the lower part of the belly (abdomen) and the pelvis.

Your brain sends information to the body through pathways known as nerves. Nerves also receive information from the body and send it to the correct regions of the brain. A nerve plexus is a place in the body where many different nerves come together and cross. Nerves that communicate some types of pain signals from the lower belly and pelvis pass through the superior hypogastric plexus on their way to the brain.

Your superior hypogastric plexus sits in front of the spine in the lower part of your back. Nerves from several parts of the lower belly and pelvis pass through this plexus. That includes nerves from the following organs:

Bladder or urethra
Lower intestines
Uterus, ovaries, or vagina
Prostate, testicles, or penis

During an SHPB, a healthcare provider will place needles in your back on both sides of the spine. They will move them to a position in front of the spine where the superior hypogastric plexus is located. Then they will inject medicine into the area to ease pain.

Why might I need a superior hypogastric plexus block?

You might need an SHPB if you have pain in the lower belly or pelvis that stems from dysfunction or damage in the pelvic organs. Another name for pain from your organs is visceral pain. This type of pain is often constant and deep. It can spread out through the lower belly and pelvis rather than be just in a certain spot.

For example, an SHPB might help your pain if you have:

Ovarian, cervical, or uterine cancer
Prostate or colon cancer
Bladder cancer
Endometriosis
Injury to the pelvis from surgery or radiation treatment
Ongoing (chronic) low belly or pelvic pain

Your healthcare provider may use SHPB to diagnose the cause of your pain. They can do so by injecting numbing medicine (local anesthetic) in the area to see if your pain improves. The shot helps to pinpoint the pelvic organs as the source of pain. In other cases, SHPB can be used to treat your pain with injection of other medicine in the area.

What are the risks of a superior hypogastric plexus block?

SHPB is generally safe. Some possible risks of the procedure are:

Short-term (temporary) drop in blood pressure
Damage to nearby nerves
Damage to the spinal cord
Damage to nearby organs
Damage to nearby blood vessels
Bleeding
Infection
Allergic reaction to the medicines

If you get steroid medicine in your injection, you may have side effects. These include temporary increases in blood sugar levels for 1 to 2 days, an allergic reaction, and flushing of your face. There is also a risk that the procedure won't ease your pain.

You may not be able to have the procedure if you have a high risk of bleeding or if you have an infection in the region of the injection. Your own risk may vary based on your age and other health problems. Before your procedure, talk with your healthcare provider about all your concerns.

How do I get ready for a superior hypogastric plexus block?

You will talk with your healthcare provider about your health history. Let them know if you have an infection, fever, or other recent health problems. If you use any blood-thinning medicines, check about special safety measures you might need to take.

You should also discuss all your medicines with your provider. You may need to stop taking certain medicines a few days beforehand. Also be sure to tell your provider if you:

Have any allergies
Have had any problems with contrast dyes, past injection procedures, anesthesia, or other medicines
Are breastfeeding, pregnant, or think you might be pregnant

Follow any directions you are given for not eating or drinking before the procedure. You may get medicine to help you relax during the SHPB. You should arrange to have someone drive you home afterward. Check with your healthcare provider about any other specific ways you should get ready.

What happens during a superior hypogastric plexus block?

Your exact procedure may differ. But general steps for an SHPB might include the following:

You will lie on your stomach on a procedure table.
You may get medicine to help you relax (sedation).
During the procedure, your heart rate, blood pressure, and oxygen level will be watched. You may get extra oxygen by a mask or nasal tubing.
The area of your lower back where you will have the injection will be cleaned.
The healthcare provider will use medicine to numb the injection area. It may burn and sting a little. But it should last only a few seconds.
The provider inserts 2 needles into your lower back, near each hip bone. They will move them to the correct position. They may use live X-rays, CT imaging, or ultrasound to help guide the needles.
The provider injects a small amount of X-ray contrast dye through these needles to make sure they are in exactly the right spot.
The provider injects medicine through the needles. They may use different types of medicines for different reasons. Numbing medicine may be needed to block pain signals. Steroid medicine may be needed to reduce inflammation. Sometimes the provider will use other medicines to temporarily damage the nerves. It stops them from transmitting pain. After the shot, you may feel a warm or burning feeling in the area.

What happens after a superior hypogastric plexus block?

You will likely be watched for 30 to 60 minutes after the procedure. Then you will need to have someone drive you home. You should not plan on doing anything strenuous or anything that requires your full attention for the rest of the day.

Ask your healthcare provider about any activity restrictions after the procedure. You should be able to eat and drink normally. Ask your provider when you should resume your normal medicines. Follow all your provider’s directions for care.

It is common to have pain at the injection site for a day or two. Many people feel pain relief soon after the procedure. It might last a few hours, a few weeks, or longer depending on the medicines used.

You should call your healthcare provider if you have any of the following symptoms:

Severe pain
Weakness or numbness in the legs
Fever
Signs of infection at the site of the injection, such as redness, swelling, and oozing.
Bleeding at the site of the injection.

Your healthcare provider can give you other specific directions about what you should do and what you can expect after the SHPB. You will need to follow up with your provider to discuss the effects of the SHPB and make a plan for future treatment of your pain.