Hypogastric Plexus Blocks

The hypogastric plexus is targeted with a block and/or neurolysis for the treatment of various etiologies of chronic visceral pelvic pain (including but not limited to cancer pain) originating from organs within the pelvis that are refractory to conventional treatment. The hypogastric sympathetic plexus includes the superior hypogastric and inferior hypogastric plexus that extends between L5 and S4. Visceral afferent nerve fibers travel with efferent sympathetic fibers such that blockade (or neurolysis) of the hypogastric plexus may provide pain relief. Fluoroscopic guidance of the superior hypogastric block has been described in a traditional paravertebral approach or a transdiscal approach, while the inferior hypogastric plexus has been described with a transsacral approach. Ultrasound and computed tomography guided approaches for hypogastric plexus blocks have also been described.