Inferior hypogastric plexus blockade: a transsacral approach.
BACKGROUND
Despite recent refinements in the technique of hypogastric plexus blockade, the lower pelvic organs and genitalia are innervated by fibers from the pre-sacral inferior hypogastric plexus and these fibers are not readily blocked using paravertebral or transdiscal approaches.


METHODS
Report of a technique to introduce a transsacral approach to blockade of the inferior hypogastric plexus.


METHODS
A technique for performing inferior hypogastric plexus blockade by passing a spinal needle through the sacral foramen is described with 15 blocks in 11 patients.


RESULTS
Fifteen inferior hypogastric plexus blocks were performed on 11 female patients who presented with chronic pelvic pain. Pelvic pain was decreased following 11 of the procedures with pre- and post-pain scores (SD) of 7.4 (2.3) and 5.0 (2.7), respectively (P < 0.05). There were no complications or unusual occurrences.


CONCLUSIONS
This block can be performed safely and effectively if the interventionalist has a high degree of familiarity with sacral anatomy, refined needle steering technique, and expertise in fluoroscopy. Properly performed, transsacral blockade of the inferior hypogastric plexus is a safe technique for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera.
Schultz
David M
DM
Medical Advanced Pain Specialists, Minneapolis, MN 55433, USA. dschultz@painphysicians.com
D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001340:Autonomic Nerve Block / Q000379:methods*; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000187:drug effects; D007267:Injections; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008488:Medical Illustration; D016343:Monitoring, Intraoperative / Q000379:methods; D009339:Needles / Q000592:standards; D016602:Needlestick Injuries / Q000517:prevention & control; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012447:Sacrum / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014781:Viscera / Q000294:innervation / Q000503:physiopathology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents