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Published on: January 10, 2019
Inferior hypogastric plexus blockade: a transsacral approach
1Medical Advanced Pain Specialists, Minneapolis, MN 55433, USA. dschultz@painphysicians.com
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.
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