f. Hypogastric Plexus Block

Neurolytic blocks for the organs in thelowera abdomen

What is a hypogastric plexus block, its purpose, and how does it work?

The hypogastric plexus block: The innervation of organs such as the uterus, kidneys, and prostate is provided by the hypogastric plexus.

Anatomy of the hypogastric plexus

In which diseases is the hypogastric plexus block used?

• Uterine cancers
• Prostate cancers
• Kidney cancers.

What preparations are required before the hypogastric nerve block?

• Before the hypogastric nerve block, ask your doctor to explain the procedure in detail. Your doctor will require written consent from you, as required by law.
• Inform your doctor about all your other conditions, medications you are using, any allergens, and medications that may cause allergies. Herbal supplements like vitamin E, glucosamine, garlic, ginseng can also cause bleeding.
• Since all blood thinners, other than aspirin, should be discontinued, it is beneficial to consult your doctor.
• When going to the intervention, take all your previous tests, MRIs, computed tomography, laboratory findings with you.
• Wear comfortable clothes and leave your watch, rings, and other jewelry at home.
• Food and water intake should be stopped at least 4 hours before the procedure. However, medications required for other systemic diseases can be taken with a small amount of water.
• During the hypogastric nerve block, about 500-1000 ml of fluid is given intravenously two hours before the procedure to prevent a drop in blood pressure. The intervention is applied thereafter.
• Since a procedure called sedation will be applied during the intervention, you are not allowed to return home alone. You should come with an attendant. Also, because the applied local anesthetic can cause temporary weakness and numbness in the legs, you cannot drive.

​​​​​​​How is the hypogastric nerve block administered and how long does it take?

 

• The intervention is performed in an operating room setting under local anesthesia. During this, the blood pressure, heartbeat, and respiration are continuously monitored by an anesthesiologist. The patient is laid face down, the area is sterilized, and the necessary preparations are completed.
• Sedation is applied so that the patient does not feel pain. This ensures that the patient neither feels pain nor remembers the intervention.
• Under imaging, the entry points in the lower part of the back are determined. For this procedure, two special needles are advanced from both sides of the spine. The intervention is performed under radiological imaging guidance to avoid damage to nearby organs and significant vascular structures.
• A contrast agent is given under imaging to ensure the proper placement of the needles, and the needle position is verified once again. Then a diluted phenol solution is injected into the area. The procedure takes about half an hour and does not cause significant discomfort. Following the procedure, the patient is observed for a few hours before going home, but absolute bed rest is required for the first 24 hours.

Is the hypogastric nerve block painful?

The patient does not feel pain during the procedure because they are under sedation. However, back pain, which can be relieved with painkillers for 24-48 hours, may occur as the diluted phenol spreads into the nerve tissue. This pain also subsides later.

What should I expect from the hypogastric nerve block?

The effectiveness of the treatment varies depending on individual characteristics and the disease causing the pain. It is more effective in cancer pains originating from a single organ, such as ovarian or uterine metastases, while its effect is less in more widespread pains. The effect of the hypogastric nerve block is evaluated in two ways: a. The pain disappears completely. b. There is a significant reduction in the patient's use of morphine-like painkillers. Both situations are considered successful. After damage, every nerve in the body begins a regeneration process. Many nerves regenerate themselves. This regeneration process varies from patient to patient and is generally effective for about 6 months. The effect of the hypogastric nerve block is limited to the upper abdominal organs where the nerve spreads. The patient feels pains originating from other regions if the disease spreads to other areas.

When can I return to work after the hypogastric nerve block?

After the hypogastric nerve block, a drop in blood pressure may be observed in patients for a few days. Therefore, a few days of blood pressure monitoring and bed rest are recommended. After that, the patient can return to normal life.

What are the risks and side effects?

The main two groups of undesirable effects of the hypogastric nerve block are related to the needle and the effects of phenol.

• Needle-related problems are bleeding and infection. Since the procedure is performed under sterile conditions and using fine needles, the risk is minimal.
• The effects of phenol include temporary or permanent damage to the nerve tissue. This can cause temporary or permanent weakness, and numbness in the legs or sexual dysfunction. However, these situations are quite rare.
• If the needle tip reaches the blood vessel, the injected phenol can be distributed throughout the body and affect different organs. However, this situation can be easily prevented by checking the needle tip with contrast agent before the injection.

Are there any alternatives to the hypogastric nerve block?

Yes, there are alternatives to the hypogastric nerve block. For pain control, systemic drugs such as morphine and other opioids, nerve pain medications, and other regional blocks or neurolytic blocks can be used. These should be discussed with the healthcare provider for appropriateness depending on the individual's condition and type of pain.

Who should not receive a hypogastric nerve block?

A hypogastric nerve block should not be performed on patients with metastasis or infection in the area to be treated, and on those with an overall poor health condition.