Superior hypogastric nerve block for pelvic pain

Opioids have been used for a long period in the treatment of pelvic pain. Patients often develop tolerance to opioids or experience unpleasant side effects, necessitating discontinuance. Superior hypogastric plexus nerve block with neurolytic agents may be useful in these patients and also may help in reducing mean opioid consumption in many other patients. Published studies have established that superior hypogastric nerve blocks can significantly reduce visual analog pain scores in patients and/or decrease their opioid intake. Superior hypogastric plexus is located bilaterally at the level of the lower third of the fifth lumbar vertebral body and upper third of the first sacral vertebral body at the sacral promontory, in which it is blocked under fluroscopic guidance. Therefore, this procedure, when performed properly, could help treat patients with chronic pelvic pain, resulting in minimal side effects.