Korean J Pain.  2012 Jan;25(1):43-46. 10.3344/kjp.2012.25.1.43.

Unilateral, Single Needle Approach Using an Epidural Catheter for Bilateral Superior Hypogastric Plexus Block

• Baik JS
• Choi EJ
• Lee PB
• Nahm FS

• KMID: 2278115
• DOI: http://doi.org/10.3344/kjp.2012.25.1.43

Abstract

The superior hypogastric plexus block (SHPB) is used for treating pelvic pain, especially in patients with gynecological malignancies. Various approaches to this procedure have been reported due to the anatomic obstacles of a high iliac crest or large transverse process of the 5th lumbar vertebra. Here, we report a new technique of superior hypogastric plexus block using a unilateral single-needle approach to block the bilateral superior hypogastric plexus with a Tuohy needle and epidural catheter. We have confidence that this new technique can be another option in performing the SHPB when the conventional bilateral approach is difficult to perform.

Keyword

catheter; hypogastric plexus; nerve block; pain

MeSH Terms

Catheters
Humans
Hypogastric Plexus
Needles
Nerve Block
Pelvic Pain
Spine

Figure

• 

  Fig. 1 Simple X-ray of the lumbar spine. The enlarged right L5 transverse process can be identified (arrows).

• 

  Fig. 2 Unilateral, single-needle approach to perform the superior hypogastric plexus block. A catheter is inserted through the Tuohy needle.

• 

  Fig. 3 AP (A) and lateral views (B) of fluoroscopic X-ray of left unilateral approach. Radio-opaque dye spread from the left margin of L5 vertebral body to the right margin in the retroperitoneal space. The arrows indicate the epidural catheter tip at the level of the upper margin of the sacrum.

Reference

1. Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990; 73:236–239. PMID: 2382849.

2. Nabil D, Eissa AA. Evaluation of posteromedial transdiscal superior hypogastric block after failure of the classic approach. Clin J Pain. 2010; 26:694–697. PMID: 20664339.

3. Waldman SD, Wilson WL, Kreps RD. Superior hypogastric plexus block using a single needle and computed tomography guidance: description of a modified technique. Reg Anesth. 1991; 16:286–287. PMID: 1958609.

4. Kanazi GE, Perkins FM, Thakur R, Dotson E. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. 1999; 24:473–476. PMID: 10499763.

5. Ina H, Kitoh T, Kobayashi M, Imai S, Ofusa Y, Goto H. New technique for the neurolytic celiac plexus block: the transintervertebral disc approach. Anesthesiology. 1996; 85:212–217. PMID: 8694369.

6. Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 2005; 206:277–281. PMID: 15942158.

7. Lee YW, Yoon DM, Lee GM, Han ST, Park HJ. Trans-intervertebral disc approach of superior hypogastric plexus block for pelvic cancer pain a retrospective study. J Korean Pain Soc. 2000; 13:202–207.