Superior Hypogastric Plexus Block

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 26 January, 2011


A superior hypogastric plexus block is used to treat pelvic pain that is resistant to conservative drug therapy. It is also indicated when, despite the efficacy of pharmacotherapy, there are many intolerable drug side-effects (nausea, constipation, sedation etc).


Superior hypogastric plexus is a retroperitoneal structure located bilaterally exactly in front of the spine, between the lower third of the 5th lumbar vertebra and the upper third of the 1st sacral vertebra. It is composed of pelvic visceral afferent and efferent sympathetic nerve fibres, branches of the aortic plexus and branches of the visceral nerves. Due to its position, it innervates the majority of pelvic viscera (bladder, urethra, uterus, vulva, vagina, perineum, prostate, penis, testes, rectum and descending colon). Pain originating from the above mentioned organs, due to either benign or malignant aetiology, is very likely to be relieved with the superior hypogastric plexus block.



•    Urethra
•    Bladder
•    Uterus
•    Vagina
•    Vulva
•    Perineum
•    Prostate
•    Penis
•    Testes
•    Rectum
•    Descending colon


•    Cancer metastases
•    Εndometriosis
•    Irradiation-induced lesions


The patient is placed in the prone position with a cushion under the pelvis to reduce the normal lumbar lordosis of the spine. Under local anaesthesia in the acupuncture site, with the patient in conscious sedation and with the use of fluoroscopy, the needle is advanced to the proper site right in front of the spine between the lower third of the 5th lumbar vertebra and the upper third of the 1st sacral vertebra. The exact site of the needle is confirmed by injecting contrast medium. The same is done also from the other side of the spine.

After confirming the proper site of the tip of both needles, a drug solution is administered for diagnostic or therapeutic reasons. Following the same technique, radiofrequency can be applied to the plexus for its full deactivation. Before applying radiofrequency, a diagnostic block with local anaesthetic precedes to confirm the patient’s pain relief. Radiofrequency therapy prolongs the therapeutic result for a long period of time.
Alternatively, plexus neurolysis can be performed with alcohol infusion to ablate the plexus. However, the alcohol diffusion at the neurolysis site is uneven and special caution is needed so as not to harm the neighbouring tissues. On the contrary, radiofrequency neurolysis is absolutely targeted at the site of its application.


Superior hypogastric plexus block is a minimally invasive technique that is very effective in the treatment of chronic pelvic pain, particularly of pain secondary to malignant diseases. Published studies from international literature, support the efficacy of this technique  also in the treatment of pelvic pain of benign aetiology originating from organs with afferent nerve fibres to the superior hypogastric plexus.


The risk in this technique is very low. In fact, only one severe complication is reported in the whole international literature. In 200 patients who underwent superior hypogastric plexus block for the treatment of pelvic pain due to cancer metastases, no complication was observed (Mexican Institute of Cancer, Roswell Park Cancer Institute, and M.D. Anderson Cancer Center).

Probable risks and complications are infection, bleeding, injury of neighbouring organs, injury of iliac vessels and peripheral ischaemia.


Plancarte et al (1990) have shown that 70% of patients suffering from chronic pelvic pain of malignant aetiology who underwent superior hypogastric plexus block, reported significant pain relief according to the visual analogue scale. In 1993, De Leon-Casasola et al reported, after  completing a study, that  patients who had undergone successful superior hypogastric plexus block cut down on their consumption of opioids by 50% for the following three weeks.

In 1998, Rosenberg et al reported a case where analgesia was achieved for more than 6 months in a patient who had been suffering from chronic non-malignant pelvic pain after transurethral prostatectomy. Another published case report in 2001 mentioned the successful treatment of resistant anal pain from metastatic cervical cancer, by applying a combination of ganglion IMPAR block and superior hypogasric plexus block. At least two more studies have demonstrated significant relief from chronic pelvic pain due to endometriosis when superior hypogastric plexus block was performed.

The duration of the result varies from some weeks to even several years and is not predictable. Radiofrequency neurolysis offers longer duration of analgesia compared to block with local anaesthetic. Due to very few risks and complications, block/ neurolysis can be repeated as many times as necessary if the result is satisfactory but the duration of analgesia is short.








1. Cariati M, De Martini G, Pretolesi F, Roy MT. CT-guided superior hypogastric plexus block. J Comput Assist Tomogr. 2002 May-Jun;26(3):428-31.
2. Chan WS, Peh WC, Ng KF, Tsui SL, Yang JC. Computed tomography scan-guided neurolytic superior hypogastric block complicated by somatic nerve damage in a severely kyphoscoliotic patient. Anesthesiology. 1997 Jun;86(6):1429-30.
3. De Leon-Casasola O, Molloy RE, Lema M, Neurolytic visceral sympathetic blocks. In Benzon HT, Raja S, Molloy RE, et al (eds): Essentials of Pain Medicine and Regional Anesthesia, 2nd ed. New York, Elsevier-Churchill Livingston, 2005, pp 542-549.
4. De Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993 Aug;54(2):145-51.
5. Dooley J, Beadles C, Ho KY, Sair F, Gray-Leithe L, Huh B. Computed tomography-guided bilateral transdiscal superior hypogastric plexus neurolysis. Pain Med. 2008 Apr;9(3):345-7.
6. Erdine S, Yucel A, Celik M, Talu GK. Transdiscal approach for hypogastric plexus block. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):304-8.
7. Gamal G, Helaly M, Labib YM. Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006 Jul-Aug;22(6):544-7.
8. Kanazi GE, Perkins FM, Thakur R, Dotson E. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. 1999 Sep-Oct;24(5):473-6.
9. Michalek P, Dutka J. Computed tomography-guided anterior approach to the superior hypogastric plexus for noncancer pelvic pain: a report of two cases. Clin J Pain. 2005 Nov-Dec;21(6):553-6.
10. Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008 Sep;36(5):732-5.
11. Plancarte-Sánchez R, Guajardo-Rosas J, Guillen-Nuñez R. Superior hypogastric plexus block and ganglion impar. Techniques in Regional Anesthesia and Pain Management. 2005 April: 9(2):86-90.
12. Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997 Nov-Dec;22(6):562-8.
13. Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990 Aug;73(2):236-9.
14. Rosenberg SK, Tewari R, Boswell MV, Thompson GA, Seftel AD. Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med. 1998 Nov-Dec;23(6):618-20.
15. Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 2005 Jul;206(3):277-81.
16. Waldman SD, Wilson WL, Kreps RD. Superior hypogastric plexus block using a single needle and computed tomography guidance: description of a modified technique. Reg Anesth. 1991 Sep-Oct;16(5):286-7.
17. Wechsler RJ, Maurer PM, Halpern EJ, Frank ED. Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. July 1995 Radiology, 196, 103-106.
18. Yeo SN, Chong JL. A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix. Ann Acad Med Singapore. 2001 Nov;30(6):632-5.