Korean J Pain.  2012 Jan;25(1):38-42. 10.3344/kjp.2012.25.1.38.

A New Technique for Inferior Hypogastric Plexus Block: A Coccygeal Transverse Approach: A Case Report

• Choi HS
• Kim YH
• Han JW
• Moon DE

• KMID: 2278114
• DOI: http://doi.org/10.3344/kjp.2012.25.1.38

Abstract

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.

Keyword

hypogastric plexus; nerve block; pelvic pain

MeSH Terms

Anesthetics, Local
Autonomic Nerve Block
Humans
Hypogastric Plexus
Nerve Block
Pelvic Pain
Sympathetic Nervous System
Viscera
Visceral Pain
Anesthetics, Local

Figure

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  Fig. 1 The target anatomic landmark for the block (A) and needle entry point (B). Needle pathway (black allow).

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  Fig. 2 A 22-gause, 10-cm block needle was manually bent about 1 cm from its tip to form a 10 degrees angle.

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  Fig. 3 Inferior hypogastric plexus block after contrast injection. (A) Anteroposterior view, (B) lateral view. Contrast around the interior hypogastric plexus (arrow).

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