Hypogastric Plexus Case Study

Case Series

Superior Hypogastric Plexus Combined with

Ganglion Impar Neurolytic Blocks for Pelvic and/or Perineal Cancer Pain Relief

From: South Egypt Cancer Institute,

Anesthesia, Intensive Care, and Pain

Management, South Egypt Cancer

Institute, Assiut University, Assiut,

Egypt.

Dr. Ahmed is a Lecturer, South Egypt

Cancer Institute, Anesthesia, Intensive

Care, and Pain Management,

South Egypt Cancer Institute,

Assiut University, Assiut, Egypt. Dr.

Mohamad is a Lecturer, South Egypt

Cancer Institute, Anesthesia, Intensive

Care, and Pain Management, South

Egypt Cancer Institute, Assiut

University, Assiut, Egypt. Dr. Sahar

Mohamed. MD, Assistant Professor,

South Egypt Cancer Institute,

Anesthesia, Intensive Care, and Pain

Management, South Egypt

1. Superior hypogastric plexus block: the posteromedian transdiscal approach. www.painphysicianjournal.com E51

Superior Hypogastric Plexus Combined with Ganglion Impar Neurolytic Blocks otic was given 30 minutes before the procedure, which were all performed under sterile conditions with c-arm fluoroscopic guidance. This approach is performed with the patient in the lateral or prone position. The

L5-S1 interspace was identified under fluoroscopy, the skin overlying the interspace was sterilized and infiltrated with 2 – 3 mL of local anesthetic (lidocaine 2%), a 20-gauge, 15 cm needle with a 30° short bevel (Chiba needle) was inserted perpendicular to the skin at the center of the L5-S1 intrelaminar space under anteroposterior fluoroscopic vision. Under lateral fluoroscopic control, the needle was then advanced towards the intervertebral disc so that it penetrated the thecal sac.

After confirming the avoidance of nerve injury by the absence of paresthesia, the tip of the needle was advanced through the intervertebral disc until it exited at its anterior surface. Correct positioning was confirmed by administration of 4 mL of soluble contrast medium in both lateral and antero-posterior fluoroscopic

The patient was discharged after 24 hours, to be followed up for the next 2 months at the first, second, and fourth weeks, then at the end of the second month.

Statistical analysis

Data were analyzed using Statistical Package for Social

Science (SPSS version 16). Values are shown as mean

± SD, range, percentage, and number. Statistical analysis was performed with the use of the Mann-Whitney test and Wilcoxon Signed Ranks test for the VAS and morphine consumption changed from the baseline. Statistical significance was assigned as P value less than 0.05.

Results

A total of 15 patients, following up in the pain clinic in the South Egypt Cancer Institute, underwent combined SHGP block and GI block. Demographic data, clinical data, and the mean duration of the procedure are presented in Table 1.

The SHGP block through a posteromedian transdiscal approach and GI block through a trans-sacrococcygeal approach took a mean duration time (± SD) of 31.3

± 6.7 minutes with a minimum and maximum duration of 20 and 45 minutes, respectively.

A successful needle placement for SHGP