What Is a Hypogastric Plexus Block?

Hypogastric Plexus Block (HPB)

- Nerve Block Level: Sympathetic chain L1-L2 in retroperitoneum, lateral to aorta and IVC, anterior to bodies of L1 and L2

- Technique: Performed under moderate sedation and ultrasound visualization. After placing ultrasound transducer in right paraspinal location lateral to the aorta at L1-L2, an introducer needle passed to inject radiocontrast to locate proper anatomical structures. If contrast spreads between aorta and IVC (anterior paravascular space/PPS), catheter inserted and pulled back slowly with aliquots of 0.25% bupivacaine for complete PPS spread

- Distribution of Block: Splanchnic and pelvic innervation from T10-L1 is interrupted, resulting in sympathetic/visceral analgesia to ipsilateral abdominal contents (celiac plexus) and pelvic area below T12 (inferior mesenteric and hypogastric nerves)

- Indications:

- Abdominal or pelvic visceral pain not responsive to lower doses of intravenous or neuraxial opioids due to pancreatitis, trauma, abdominal aneurysm repair, mesenteric ischemia, retroperitoneal malignancy/trauma, postoperative ileus

- Chronic pelvic pain such as chronic prostatitis/epididymitis, interstitial cystitis/painful bladder syndrome

- Absolute Contraindications:

- Uncontrolled coagulopathy, infection overlying injection site/retroperitoneum/nephrocutaneous fistula site, bowel perforation

- Relative Contraindications:

- Renal/liver insufficiency or dysfunction, intra-abdominal aortic aneurysm (HPB will likely worsen ischemia distally), significant cardiovascular dysfunction