A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach.
Superior hypogastric plexus block has been advocated for the treatment of cancer related pelvic pain. Neurolysis is usually established using the classical posterolateral approach in the prone position, in which correct placement of the needle is sometimes difficult due to vertebral anatomy and the patient's inability to lie prone. We describe an alternative posteromedian transdiscal approach under fluoroscopic guidance for the treatment of intractable pelvic pain in three patients, in whom the classical approach was not possible. The L5-S1 interdiscal space was identified with fluoroscopy. The needle was then introduced through the disc and advanced under lateral fluoroscopic control. After verifying correct needle placement, neurolysis was performed with 8 ml of 10% phenol solution. All patients had significant pain relief immediately after the block, lasting from 6 to 12 months, and their pain severity scores and opioid consumption were reduced by more than 50%. There were no complications such as discitis, disc rupture or nerve injury. Since this new posteromedian transdiscal approach provides easy access to the superior hypogastric plexus with a single puncture and with any patient position, it may be an alternative to the classical approach.
Turker
Gurkan
G
Department of Anesthesiology, Uludag University, Faculty of Medicine, Bursa, Turkey. gturker@uludag.edu.tr
Basagan-Mogol
Elif
E
Gurbet
Alp
A
Ozturk
Cagatay
C
Uckunkaya
Nesimi
N
Sahin
Sukran
S
D000368:Aged; D001340:Autonomic Nerve Block; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology*; D008160:Lumbosacral Plexus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000188:drug therapy / Q000209:etiology; D019800:Phenol / Q000494:pharmacology; D013131:Spine; D013997:Time Factors
D003287:Contrast Media; D019800:Phenol