Hypogastric plexus block

The lumbar sympathetic chain is located close to the anterolateral aspect of the spine, in front of the psoas muscle and behind the inferior vena cava and the aorta. A 22-gauge needle is inserted at the level of L3-L4. CT scan confirms the correct position of the needle tip. After injection of 2 ml of hdocaine diluted with contrast medium the location of the needle tip is confirmed. The contrast solution should stagnate in the retroperitoneal fat behind retroperitoneal vessels. Neurolysis is performed by slow injection of 5-10 ml of 96% ethanol (Fig. 11.5). Only one side should be performed per session and a time interval of 6-8 weeks should be observed before the opposite side is blocked to prevent the risk of orthostatic arterial hypotension (Kurdziel and Dondelinger 1990 Schild 1998 Bonica 1990b). Hypogastric plexus block is performed at L5. 

Wechsler RJ et al (1995) Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis CT techniques and results. Radiology 196 103-106 Whiteman MS et al (1986) Celiac plexus block for interventional radiology. Radiology 161 836-838... 

Pain caused by cancer of the pelvic viscera, and severe persistent tenesmus. All nociceptive pathways from the uterus and cervix pass through the lumbar sympathetic chain. In cases where persistent pain caused by cancer limited to the uterus is not amenable to the other forms of treatment, bilateral sympathectomy can be considered (Bonica 1990a,b). Block of the superior hypogastric plexus has been advocated as... 

---