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Hypogastric Plexus Block


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 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 vagina 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 of 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 hours prior to the procedure.
We require that you be accompanied to and from the Center by a responsible adult driver. Most likely you will be offered a small dose of intravenous medication during the procedure which will act to not only decrease anxiety, but provide you some pain relief from the minor discomfort of the procedure itself. This intravenous medication will also impair your driving ability.

What happens during the procedure?

First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.
You will then be positioned on your stomach. The physicians will 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 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 after the procedure?

After the hypogastric plexus block is performed, we will continue to monitor you in the recovery room for 30 to 40 minutes. If there are no signs of any problems, you will be ready to leave. If you have any questions after your procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week.

Will my insurance cover the procedure?

The hypogastric plexus block is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

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 physicians have 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.

What should I do if any problems develop after I leave?

If you have any questions after the procedure, the medical staff of the Pain Management Center is on call 24 hours a day, 7 days a week.

Post procedure instructions

These will be provided for you, in further detail, by the recovery room nurse prior to your discharge from the Ambulatory Surgery Center. These instructions should include: no driving or operating heavy machinery for 24 hours after the procedure. This is recommended due to the fact that you have received intravenous medication during a procedure which may impair your ability to perform these tasks.