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Hypogastric Plexus Block

What is a hypogastric plexus block?

Hypogastric plexus blocks are injections of medication that help relieve pelvic pain. The pain may come from the colon, bladder, lower intestines, uterus or ovaries, prostate or testicles, or other parts of the pelvis. The procedure also can help reduce pelvic pain from endometriosis, irritable bowel syndrome, radiation injury and cancer in the pelvis.

The hypogastric plexus is a bundle of nerves near the bottom of your spinal cord. Blocking these nerves from carrying pain information can help you stop feeling pain in your pelvis.

How is a hypogastric plexus block done?

First, you’ll be given an intravenous medication to relax you. Then, you’ll lie on your stomach on an x-ray table.

The doctor will numb an area of skin on your back with a local anesthetic. Then, guided by an x-ray, he or she will:

  • Insert two needles into your back, near each hip bone
  • Inject dye to confirm that medication will go to the correct spot
  • Inject pain medication, including a steroid for longer-term relief; alcohol or phenol also may be injected to destroy the nerves

Usually, the procedure takes about 30 minutes. Then you’ll stay for observation for at least 30 minutes. Most people go home soon after.

How effective is a hypogastric plexus block?

Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work.

How long the pain stays away is different for each patient. For some, the relief lasts weeks. For others, the relief lasts years.

If the pain returns, you can have another hypogastric plexus block every few months.

What are the risks?

The risk of complication from a hypogastric plexus block is very low. However, there could be bruising or soreness at the injection site. Serious complications, such as infection, nerve damage and bleeding, are uncommon.

Side effects of the steroid medication are rare but can include:

  • Flushed face
  • Slight fever
  • Hiccups
  • Insomnia
  • Headache
  • Water retention
  • Increased appetite
  • Increased heart rate
  • Abdominal cramping or bloating

These effects resolve within a few days.

What happens after the procedure?

Your pelvic area may feel warm or “different,” and you may begin to feel less pelvic pain.

You can continue your regular diet and medications immediately, but do not drive or do any rigorous activity for 24 hours after the procedure. Take it easy. You can return to your normal activities the next day.

Is a hypogastric plexus block right for you?

A hypogastric plexus block may be right for you if you have chronic pelvic pain that does not respond to oral pain medication. These injections may give you more relief while taking less pain medication.

Talk to your physician about it. To schedule an evaluation at Cleveland Clinic’s Department of Pain Management call 216.444.PAIN (7246) or 800.392.3353.