Inferior hypogastric plexus

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. 

---