A hypogastric block is a minimally invasive procedure that helps relieve chronic pelvic pain. The superior hypogastric plexus, a network of nerves in the pelvis, supplies organs within the pelvic cavity, such as the rectum, bladder, prostate, uterus, and vagina. If damaged, these nerves can cause severe, radiating pain within the pelvis. A hypogastric block is performed on patients with pelvic pain that has not responded to conservative treatments, medications, or other nerve blocks. Patients with pelvic cancer pain, endometriosis, irritable bowel syndrome, fibroids, interstitial cystitis, and other male and female genital pain conditions may find relief from a hypogastric block.
A hypogastric block is an outpatient procedure that may require a local anesthetic, intravenous sedation, or anesthesia to minimize discomfort. Depending on the location of the patient’s pain, a physician may administer treatment from an anterior, posterior, or transdiscal approach. Generally, x-ray imaging and fluoroscopy are used to locate and effectively deliver treatment to the area causing pain. Before the procedure begins, the patient will lie face down with a pillow under their abdomen. Various monitoring devices will be attached to the patient’s body to record their heart rate, blood pressure, and oxygen level. A local anesthetic is used to numb the skin before the needle is inserted. The physician will insert the needle through the lower back under x-ray guidance, and once the needle is in a proper position, a contrast dye will be injected for accuracy. Shortly after, a local anesthetic with a neurolytic agent is injected into the nerves to provide pain relief. Within a matter of minutes, patients may experience relief. If this happens, the procedure is deemed a success. After the injection, the needle is removed and a bandage is placed over the injection site.
If intravenous sedation is given during the procedure, a loved one or family member must be available to drive the patient home after their treatment. There are many blood vessels in the area being injected; therefore, the local anesthetic may cause these vessels to dilate. As a result, a patient’s blood pressure could drop shortly after the procedure. IV fluids will be administered to increase circulating blood volume and stabilize blood pressure before the patient is discharged. Following a hypogastric block, patients may experience soreness at the injection site, muscle spasms, or cramping in the back or lower abdomen. To mitigate these symptoms, patients should apply ice to the injection site for 10 minutes several times a day. For the remainder of the day, patients will be advised to rest and drink plenty of fluids. Patients may experience immediate pain relief. Sometimes, this response is delayed several hours. If successful, pain relief can last several hours to several days. Should any adverse effects develop, patients are encouraged to call Orthopedic and Wellness and report them immediately.