Hypogastric Plexus Block

What is a hypogastric plexus block?

A hypogastric plexus block is a pain-relieving injection into a bundle of nerves near the bottom of your spine (the hypogastric plexus). Blocking the hypogastric plexus causes the nerves to stop carrying information about pain in your pelvic area. This can reduce pain in your lower abdomen.

You may only need one injection or your provider may give you a series of injections as needed.

What are the types of hypogastric plexus blocks?

There are two types of hypogastric plexus blocks based on the location:

• Superior hypogastric plexus block: This is the upper part of the hypogastric plexus in your lower back.
• Inferior hypogastric plexus block: This is the lower part of the hypogastric plexus near your tailbone.

Your healthcare provider will inject medication onto a specific part of the nerve plexus, depending on the source of pain.

What does a hypogastric plexus block treat or manage?

A hypogastric plexus block can help you manage pain in your lower abdomen and pelvis area, including your:

• Bladder.
• Colon.
• Lower intestines.
• Prostate or testicles.
• Uterus or ovaries.

You may need a hypogastric plexus block if the pain in your pelvic area is long-lasting and oral medications (taken by mouth) aren’t enough to relieve it. Pain could happen with the following:

• Cancer.
• Endometriosis.
• Injury or trauma (like surgery or radiation therapy).
• Interstitial cystitis.
• Irritable bowel syndrome.
• Pelvic complex regional pain syndrome.
• Pelvic inflammatory disease.

How should I prepare for a hypogastric plexus block?

Your healthcare provider will give you specific instructions to follow before a hypogastric plexus block. Their instructions may include:

• Don’t eat or drink anything a few hours before the procedure.
• Under your provider’s supervision, stop taking certain medications before the day of your procedure. Don’t stop or start taking medications unless your provider approves it.
• Make arrangements for someone to drive you to and from your appointment.

Your provider will let you know what type of medication they plan on using and how long they expect pain relief to last, which varies.

Is a hypogastric plexus block an outpatient or inpatient procedure?

A hypogastric plexus block is an outpatient procedure. You’ll be able to go home when the procedure is over.

What kind of healthcare provider performs a hypogastric plexus block?

Interventional pain management physicians perform the procedure. These are providers who specialize in diagnosing and treating conditions that cause pain.

What happens during a hypogastric plexus block?

During a hypogastric plexus block, your healthcare provider may:

1. Give you a sedative through a needle in a vein in your arm. This intravenous (IV) medication can relax you.
2. Guide you to lie on your stomach on an X-ray table.
3. Clean your skin and give you a local anesthetic injection to numb your lower back area.
4. Use an X-ray to guide two needles into your lower back.
5. Inject dye to confirm that the medication will go to the correct spot.
6. Inject pain medication into the plexus. This may include an anesthetic and/or a steroid.
7. Inject alcohol or phenol to destroy the nerves completely for long-term pain relief.

How long does a hypogastric plexus block take?

The procedure usually takes about 30 minutes. Then, you’ll stay for observation for at least 30 minutes. You should be able to go home shortly after an hour.

Will I be asleep during a hypogastric plexus procedure?

No, you’ll be awake during a hypogastric plexus procedure. Your provider will give you a sedative to relax you, but you won’t be asleep. Your healthcare provider may ask you questions during the procedure to assess your comfort level.

What can I expect after a hypogastric plexus block?

Your pelvic area may feel warm or “different” after the procedure. This is normal. Many people report feeling less pelvic pain 30 minutes after the injection.

It’s also normal to have bruising or soreness at the injection site. This may last for a couple of days. Let your provider know if you feel severe pain after the injection.

What are the benefits of a hypogastric plexus block?

The main benefit of a hypogastric plexus block is lower abdominal or pelvic pain relief. It may reduce how often you need to take oral pain medications to manage this symptom.

What are the risks or complications of a hypogastric plexus block?

Your risk of complications from a hypogastric plexus block is low. However, complications are possible and may include:

• Allergic reaction to medication.
• Bleeding.
• Infection (like fever, severe pain or swelling at the injection site).
• Nearby organ or blood vessel damage.
• Nerve damage outside of the plexus.

What is the recovery time after a hypogastric plexus block?

After the injection, you’ll need to rest at home. Avoid participating in strenuous activities for 24 hours. You can return to your normal physical activities the next day. You can eat and drink as you normally would immediately after the procedure.

Follow your provider’s instructions on when to restart your usual medications again. If you made any changes to your medications before the injection, your provider will tell you when it’s safe to get back to your normal schedule.

How long do hypogastric plexus blocks last?

Pain relief varies based on what medicine your provider uses during a hypogastric plexus block. For example, an anesthetic offers temporary pain relief, usually for hours or days. Steroids may offer longer pain relief, usually weeks to months. You may need multiple injections or a combination of different medicines for optimal relief. Your provider will let you know what to expect before the injection.

When should I call my healthcare provider?

Contact your healthcare provider if pain increases or doesn’t go away. Let them know if you have side effects, like a fever, severe pain and swelling at the injection site, or weakness in your legs.