Pain Management Procedures
Superior Hypogastric Plexus Block
Superior Hypogastric Plexus Block
What is it?
The superior hypogastric plexus is a network of sympathetic nerves in front of the lower spine that carries pain signals from pelvic organs. A block places local anesthetic, and sometimes a longer-acting medication, near this plexus to reduce selected pelvic pain.
When may it be recommended?
It may be considered for severe, persistent pelvic or lower-abdominal pain that has not improved with appropriate treatment, including pain related to cancer, endometriosis, pelvic surgery, or other well-evaluated pelvic conditions. “Hypogastric nerve block” should be published as superior or inferior hypogastric plexus block only after APG confirms the intended target; these are different procedures.
What happens?
The superior plexus lies near the L5-S1 junction and major pelvic blood vessels. Using fluoroscopy, CT, or another imaging method, the clinician advances one or two needles from the back, side, or occasionally front. Contrast confirms position before medication is injected.
What should I expect?
Temporary warmth, numbness, low blood pressure, or changes in pelvic sensation can occur. Relief may be diagnostic and short or may last longer, depending on the medication and condition.
Important risks
Risks include bleeding, infection, medication reaction, low blood pressure, nerve injury, vascular injury, and puncture of bowel, bladder, ureter, disc, or another pelvic structure. Sexual or urinary effects are possible. The procedure requires a specific diagnosis and should be coordinated with the specialists managing the pelvic condition.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.