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.