The Optimal Approach for a Superior Hypogastric Plexus Block.

Area of Science:

• Pain Management
• Interventional Radiology
• Anatomy

Background:

• Superior hypogastric plexus block (SHGPB) is a complex procedure with potential complications.
• Accurate technique is crucial for effective pain relief in pelvic malignancies.

Purpose of the Study:

• To determine reference angles for fluoroscopy-assisted SHGPB.
• To establish a predictor for selecting between posterior and transdiscal approaches.

Main Methods:

• Abdominopelvic CT scans of 268 patients with pelvic malignancies were analyzed.
• Fluoroscopic angles for posterior and transdiscal approaches were simulated.
• A novel SHGPB index was developed to assess bony pelvis dimensions.

Main Results:

• Significant differences in the right oblique angle for the posterior approach were found between males (14°) and females (19°).
• An SHGPB index < 150 independently predicted failure of the classic posterior approach (OR 31.3).

Conclusions:

• Optimal fluoroscopic angles for the posterior approach vary by sex.
• The SHGPB index can guide the selection of the transdiscal approach for narrower pelves, enhancing SHGPB procedural success.