Transdiscal approach for hypogastric plexus block.
OBJECTIVE
In this study, we have performed hypogastric plexus block using a posterior transdiscal approach in 20 patients diagnosed with pelvic pain because of cancer.


METHODS
The L(5)-S(1) interdiscal space was identified with fluoroscopy. A needle attached to a 5-mL syringe was introduced through the disc and advanced under lateral fluoroscopic control until resistance was lost. After verifying proper position, 5 mL of 10% aqueous phenol was administered through the needle. After drawing back the needle, cephazolin 50 mg in 1 mL was administered to the disc to prevent discitis. The visual analog scale (VAS) values, daily analgesic requirements, and patient satisfaction were evaluated before the procedure, at 24 hours and then every month for 3 months after the procedure.


RESULTS
Disc puncture was performed without difficulty in all patients, there were no complications associated with disc puncture such as discitis or disc rupture. Twelve patients had statistically significant pain relief immediately after the block (P <.05). Fifteen patients were satisfied after the block, and their daily analgesic requirement decreased significantly. No pain relief was observed in 5 patients.


CONCLUSIONS
Transdiscal approach to the hypogastric plexus appears to be a safe and effective procedure. However, prospective randomized controlled studies comparing different approaches are needed to increase our knowledge of hypogastric plexus block.
Erdine
Serdar
S
Department of Algology, Medical Faculty of Istanbul, Istanbul University, Capa Klinikleri 34390, Istanbul, Turkey. algotur@superonline.com
Yucel
Aysen
A
Celik
Mehmet
M
Talu
Gul K
GK
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D017699:Pelvic Pain / Q000188:drug therapy / Q000209:etiology; D013131:Spine
D000779:Anesthetics, Local