scholarly journals Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
A. Stogicza ◽  
A. M. Trescot ◽  
E. Racz ◽  
L. Lollo ◽  
L. Magyar ◽  
...  
Keyword(s):  
Perineal Pain ◽  
Forensic Sciences ◽  
Blue Dye ◽  
Nerve Roots ◽  
Inferior Hypogastric Plexus ◽  
Sacral Nerve ◽  
Fresh Cadaver ◽  
Hypogastric Plexus ◽  
Transsacral Approach ◽  
Superior Hypogastric Plexus

Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.

scholarly journals Chemical Neurolysis of the Inferior Hypogastric Plexus for the Treatment of Cancer-Related Pelvic and Perineal Pain

2013 ◽  
Vol 18 (5) ◽  
pp. 249-252 ◽  
Author(s):  
Sahar Abd-Elbaky Mohamed ◽  
Doaa Gomaa Ahmed ◽  
Mohamad Farouk Mohamad
Keyword(s):  
Oral Morphine ◽  
Good Alternative ◽  
Perineal Pain ◽  
Inferior Hypogastric Plexus ◽  
Patients With Cancer ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Chronic Pain Conditions ◽  
Ganglion Impar Block ◽  
Plexus Block

BACKGROUND: Various interventions, including the superior hypogastric plexus block and ganglion impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics/steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer.OBJECTIVES: To assess the feasibility, safety and efficacy of the newly introduced inferior hypogastric plexus block, performed using a trans-sacral approach, for the relief of cancer-related pelvic and perineal pain.METHODS: A total of 20 patients with cancer pain in the pelvis and/or perineum were injected with 6 mL to 8 mL of 10% phenol bilaterally by passing a spinal needle through the sacral foramen to perform the inferior hypogastric block. Pain intensity (measured using a visual analogue scale), sleep score, activity score, psychological score and oral morphine consumption pre- and postprocedure were measured.RESULTS: Two of the 20 patients died during the follow-up period and were, therefore, excluded from the study. All patients presented with cancer-related pelvic, perineal or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.22±1.31 preprocedurally to 4.06±1.73 one week postprocedurally (P<0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 106.67±32.90 mg to 61.67±40.48 mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block.DISCUSSION AND CONCLUSION: The approach provides a good alternative technique for the treatment of low pelvic and perineal cancer-related pain. Additional studies are required for evaluation and refinement of the technique using other radiological techniques.

scholarly journals Inferior Hypogastric Plexus Blockade: A Transsacral Approach

2007 ◽  
Vol 6;10 (6;11) ◽  
pp. 757-763
Author(s):  
David M. Schultz
Keyword(s):  
Chronic Pain ◽  
Pelvic Pain ◽  
Inferior Hypogastric Plexus ◽  
Sacral Anatomy ◽  
Hypogastric Plexus ◽  
Transsacral Approach ◽  
Superior Hypogastric Plexus ◽  
Chronic Pain Conditions ◽  
Plexus Block ◽  
High Degree

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. Design: 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. Key words: Pelvic pain, chronic pain, inferior hypogastric plexus block, superior hypogastric plexus, transsacral approach.

scholarly journals Pulsed Radiofrequency of the Sacral Roots Improves the Success Rate of Superior Hypogastric Plexus Neurolysis in Controlling Pelvic and Perineal Cancer Pain. Randomized Trial

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. 149-157
Author(s):  
Diab Fuad Hetta
Keyword(s):  
Cancer Pain ◽  
Pain Score ◽  
Pelvic Pain ◽  
Mean Difference ◽  
Perineal Pain ◽  
Pulsed Radiofrequency ◽  
Post Procedure ◽  
Hypogastric Plexus ◽  
Pelvic Cancer ◽  
Superior Hypogastric Plexus

Background: Superior hypogastric plexus neurolytic (SHP-N) block is the mainstay management for pelvic cancer pain of visceral origin when oral opioids fail due to inefficacy or intolerance to side effects. Unfortunately, SHP-N has the potential to control pelvic pain in 62%-72% of patients at best, because chronic pelvic pain may assume additional characteristics other than visceral. Objective: Combining SHP-N with pulsed radiofrequency (PRF) of the sacral roots might block most of the pain characteristics emanating from the pelvic structures and improve the success rate of SHP-N in controlling pelvic and perineal cancer pain. Study Design: This study was a prospective randomized controlled clinical trial. Settings: The research took place in the interventional pain unit of a tertiary center in the university hospital. Methods: Fifty-eight patients complaining of cancer-related chronic pelvic and perineal pain were randomized to either the PRF + SHP group (n = 29), which received SHP-N combined with PRF of the sacral roots S2-4, or the SHP group (n = 29), which received SHP-N alone. The outcome variables were the percentage of patients who showed a > 50% reduction in their Visual Analog Scale (VAS) pain score, the VAS pain score, and global perceived effect evaluated during a 3-month follow-up period. Results: The percentage of patients who showed a > 50% reduction in their VAS pain score was significantly higher in the SHP + PRF group compared to the SHP group when assessed at one month (92.9% [n = 26] vs 57.7% [n = 15]; P = .003) and 3 months (85.7% [n = 24) vs 53.8% [n = 14]; P = .01) post procedure, respectively. However, no significant difference was observed between the 2 groups at the 6-month evaluation (SHP + PRF [57.1% (n = 16)] vs SHP [50% (n = 13)]; P = .59). There was a statistically significant reduction of VAS in the SHP + PRF group in comparison to the SHP group at one month (2.8 ± 0.9 vs 3.5 ± 1.2 [mean difference, -0.7 (95% confidence interval [CI], -1.29 to -0.1), P = .01]), 2 months (2.8 ± 0.9 vs 3.5 ± 1.2 [mean difference, -0.64 (95% CI, -1.23 to -0.05), P = .03]), and 3 months (2.7 ± 1 vs 3.4 ± 1.2 [mean difference, -0.67 (95% CI, -1.29 to -0.05)], P = .03]) post procedure, respectively; however, the 2 groups did not significantly differ at 2 weeks, 4, 5, and 6 months post procedure. Regarding postprocedural analgesic consumption, there were trends towards reduced opioid consumption at all postprocedural measured time points in the SHP+PRF group compared to the SHP group; these differences reached statistical significance at 2 months (median, 30 [interquartile range (IQR), 0.00-30] vs median, 45 [IQR, 30-90]; P = .046) and 3 months (median, 0.00 [IQR, 0.00-30] vs median, 30 [IQR, 0.00-67.5]; P = .016) post procedure, respectively. Limitations: The study follow-up period is limited to 6 months only. Conclusions: SHP-N combined with PRF of the sacral roots (S2, 3, 4) provided a better analgesic effect than SHP-N alone for patients with chronic pelvic and perineal pain related to pelvic cancer. Trial Registry: ClinicalTrials.gov. NCT03228316. Key words: Pelvic pain, pulsed radiofrequency, sacral roots, superior hypogastric plexus

scholarly journals Superior Hypogastric Plexus Combined with Ganglion Impar Neurolytic Blocks for Pelvic and/or Perineal Cancer Pain Relief

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E49-E56
Author(s):  
Doaa Gomaa Ahmed
Keyword(s):  
Cancer Pain ◽  
Pelvic Pain ◽  
Small Sample Size ◽  
Oral Morphine ◽  
Small Sample ◽  
Perineal Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Neurolytic Block ◽  
Ganglion Impar

Background: The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature. Objectives: To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the transsacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes. Methods: Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 – 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured. Results: All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or serious side effects were encountered during or after the block. Limitations: This study is limited by its small sample size and non-randomized study. Conclusion: A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach. Key words: Superior hypogastric plexus block, ganglion impar block, cancer pain, pelvic pain, perineal pain

scholarly journals Cryoanalgesia for Intractable Perineal Pain1

1981 ◽  
Vol 74 (11) ◽  
pp. 804-809 ◽  
Author(s):  
P J D Evans ◽  
J W Lloyd ◽  
T M Jack
Keyword(s):  
Median Duration ◽  
Local Application ◽  
Perineal Pain ◽  
Nerve Roots ◽  
Sacral Nerve ◽  
Pelvic Cancer ◽  
Sacral Hiatus ◽  
Extreme Cold ◽  
Sacral Canal

Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through the sacral hiatus into the sacral canal to produce anaesthesia of the lower sacral nerve roots. Forty patients received a total of 70 treatments: 31 patients (78%) were helped by the procedure and the median duration of improvement was 30 days. The treatment was more successful in relieving symptoms in patients suffering from pelvic cancer and coccydynia. The best results were obtained in those patients who received numerous freeze applications or prolonged freezing.

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