Superior Hypogastric Plexus Block

What is a superior hypogastric plexus block?

A superior hypogastric plexus block (SHPB) is a type of shot (injection). It’s used to diagnose and treat pain in the lower part of the belly (abdomen) and the pelvis.

Your brain sends information to the body through the nerves. Nerves also receive information from the body and send it to the brain. A nerve plexus is a place in the body where many different nerves come together and cross. Nerves that send pain signals from the lower belly and pelvis pass through the superior hypogastric plexus on their way to the brain.

Your superior hypogastric plexus is located in front of the spine in the lower part of your back. Nerves from parts of the lower belly and pelvis pass through this plexus. That includes nerves from these organs:

• Bladder or urethra

• Lower intestines

• Uterus, ovaries, or vagina

• Prostate, testicles, or penis

During an SHPB, a doctor will place needles in your back on both sides of the spine. They will move them to a place in front of the spine. This is where the superior hypogastric plexus is located. Then they will inject medicine into the area to ease pain.

Why might I need an SHPB?

You might need an SHPB if you have pain in the lower belly or pelvis that's caused by a problem in the pelvic organs. It's called visceral pain. This type of pain can be constant and deep. It can spread out through the lower belly and pelvis instead of in just one spot.

For example, an SHPB might help your pain if you have:

• Ovarian, cervical, or uterine cancer.

• Prostate or colon cancer.

• Bladder cancer.

• Endometriosis.

• Injury to the pelvis from surgery or radiation treatment.

• Ongoing (chronic) low belly or pelvic pain.

Your doctor may use SHPB to find out what's causing your pain. They inject numbing medicine (local anesthetic) in the area to see if your pain improves. The shot helps to pinpoint the pelvic organs as the source of pain. In other cases, SHPB can be used to treat your pain with injection of other medicine in the area.

What are the risks of an SHPB?

SHPB is generally safe. Some possible risks of the procedure are:

• Short-term (temporary) drop in blood pressure.

• Damage to nearby nerves.

• Damage to the spinal cord.

• Damage to nearby organs.

• Damage to nearby blood vessels.

• Bleeding.

• Infection.

• Allergic reaction to the medicines.

If you get steroid medicine in your injection, you may have side effects. These include:

• Increases in blood sugar levels for 1 to 2 days.

• An allergic reaction.

• Flushing of your face.

• The procedure won't ease your pain.

You may not be able to have the procedure if you have a high risk of bleeding or if you have an infection in the region of the injection. Your own risk may vary based on your age and other health problems. Before your procedure, talk with your doctor about all your concerns.

How do I get ready for an SHPB?

Your doctor will ask about your health history. Let them know if you have an infection, fever, or other recent health problems. If you use any blood-thinning medicines, check about special safety measures you might need to take.

Discuss all your medicines with your doctor. You may need to stop taking certain medicines a few days beforehand. Also be sure to tell your doctor if you:

• Have any allergies.

• Have had any problems with contrast dyes, past injection procedures, anesthesia, or other medicines.

• Are breastfeeding, pregnant, or think you might be pregnant.

Follow any directions you are given for not eating or drinking before the procedure. Arrange to have someone drive you home afterward. Check with your doctor about any other ways you should get ready.

What happens during an SHPB?

Here are the general steps for an SHPB:

• You'll lie on your stomach on a procedure table.

• You may get medicine to help you relax (sedation).

• During the procedure, your heart rate, blood pressure, and oxygen level will be watched. You may get extra oxygen by a mask or nasal tubing.

• The area of your lower back where you'll have the injection will be cleaned.

• The doctor will use medicine to numb the injection area. It may burn and sting a little. But it should last only a few seconds.

• The doctor inserts 2 needles into your lower back, near each hip bone. They'll be moved to the correct position. Live X-rays, CT imaging, or ultrasound may be used to help guide the needles.

• The doctor injects a small amount of X-ray contrast dye through these needles. This helps make sure they are in exactly the right spot.

• The doctor injects medicine through the needles. They may use different types of medicines for different reasons. Numbing medicine can block pain signals. Steroid medicine can reduce inflammation. Sometimes the doctor will use other medicines to temporarily damage the nerves. It stops them from sending pain. After the shot, you may have a warm or burning feeling in the area.

What happens after an SHPB?

You will likely be watched for 30 to 60 minutes after the procedure. Then you'll need to have someone drive you home. You should not plan on doing anything strenuous or anything that needs your full attention for the rest of the day.

Ask your doctor about any activity restrictions after the procedure. You should be able to eat and drink normally. Ask your doctor when you should resume your normal medicines. Follow all your doctor’s directions.

It's common to have pain at the injection site for a day or two. Many people feel pain relief soon after the procedure. It might last a few hours, a few weeks, or longer depending on the medicines used.

Contact your doctor if:

• You have severe pain.

• You feel weak or numb in your legs.

• You have a fever.

• There are signs of infection at the site of the injection, such as redness, swelling, and oozing.

• There is bleeding at the site of the injection.

Your doctor can give you other directions about what to do and what you can expect after the SHPB. You'll need to follow up with your doctor to discuss the effects of the SHPB. At that time, you can make a plan for future treatment of your pain.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure.

• The reason you are having it.

• What results to expect and what they mean.

• The risks and benefits of the test or procedure.

• What the possible side effects or complications are.

• When and where you are to have the test or procedure.

• Who will do it and what that person’s qualifications are.

• What would happen if you did not have it.

• Any alternative tests or procedures to think about.

• When and how will you get the results.

• Who to call after the test or procedure if you have questions or problems.

• How much will you have to pay for it.