What Is Lumbar hypogastric block?
The hypogastric block is actually two separate groups of nerves, the superior and inferior hypogastric nerves. These nerves join together to form ganglia or clusters of cell bodies that reside in front of the vertebral bodies of the uppermost lumbar spine. A hypogastric block is indicated for painful conditions of the pelvis. These include the uterus, bladder, reproductive organs, and lower parts of the rectum and colon.
Preparing for a hypogastric block: after obtaining consent, you will be positioned facedown on a fluoroscopic carbon fiber table. Fluoroscopic images will be taken to identify the best trajectory for needle placement. Often a mild sedative is administered to make you more comfortable and reduce anxiety. A very thin needle is used to target the location of the hypogastric nerve plexus and once the needle tip is in position, an x-ray Inc. or contrast is injected to identify correct placement. Images are recorded when this is satisfactory, and subsequently, a long-acting local anesthetic often with a small amount of steroid is injected.
Monitoring is continued for several minutes after the medication is injected. The needle is withdrawn pressure applied over the area along with some ice packs and the areas cleaned and a Band-Aid applied. Post-procedure, you may feel a little different in the areas of your pain. Pain reduction can be immediate and this will be recorded by your physician.
Over time this pain relief may be lasting or a repeat injection may be required. In some instances, if the pain relief is satisfactory immediately after the procedure however the pain returns repeatedly, radiofrequency ablation or other nerve destruction of the hypogastric plexus may be considered.
Often this is done in consultation with your primary care doctor and her oncologist.
Before and After the Procedure and the Risks
Before the Procedure
Patients who take a blood thinning medication (warfarin, rivaroxaban, etc.) may need to stop taking it several days prior to the procedure. Discuss your medication with your prescribing doctor as well as the physician who will perform the injection.
The injection is usually an outpatient procedure performed in a fluoroscopy suite. Please make arrangements to have someone drive you to and from the office or outpatient treatment center.
After the Procedure
You may feel a sense of warmth or fullness in the affected leg. You may also feel some temporary numbness or weakness in the limb. You will be monitored for 15 to 30 minutes. You will be discharged when you are able walk without weakness. You cannot drive the day of the procedure. Do not swim or soak in a tub for 72 hours after the procedure.
Typically, patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol).
A nerve block injection is a relatively safe procedure with minimal risk of complications. Risks of a lumbar sympathetic block include bleeding, infection, allergic reaction, nerve damage, paralysis, a drop in blood pressure, anesthetic toxicity, hematuria (blood in the urine), numbness, weakness, and medication side effects.