Superior Hypogastric Nerve Block

FINAL (2)-150.png
BackTABLEfinal-2tone_edited.png

© 2020 by Backtable. All rights reserved.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.

Overview

Overview content for Superior Hypogastric Nerve Block is not yet available.

Pre-Procedure

Indications:
• Intraoperative pain control for uterine artery embolization
• Intractable pain related to pelvic neoplasm, endometriosis, etc.

Contraindications:
• Uncorrected coagulopathy
• Allergy

Procedure

Positioning: supine or prone

Procedure often performed in setting of uterine fibroid embolization
• If femoral access, helpful to advance catheter to contralateral internal iliac artery to delineate aortic bifurcation
• If radial access, can use contrast injection to outline the bifurcation
Infraumbilical abdomen prepped
Needle: 15 cm, 20-25g Chiba or spinal needle

Target:
• Midline; lower half of L5 vertebral body
• Flatten the endplates of L5 using caudal tilt
• Advance needle to periosteum of L5 vertebral body
• Avoid disc
Collimate and use hemostats to avoid fluoroscopic exposure to hands

Confirm position:
• Lateral view
• Inject contrast: retroperitoneal, nonvascular

Medication administration:
• 3 way stopcock and microbore connection tubing helpful
• 15-25 mL of long acting anesthetic such as 0.5% Ropivacaine, 0.25% Bupivacaine, 0.5% Bupivacaine
• Maintain gentle forward pressure of needle
Remove needle

Post-Procedure

Complications:
• Intravascular injection resulting in cardiac arrest or seizure
• Bowel or vascular injury
• Infection: discitis
• Bleeding
• Major complications uncommon



Related Procedures

No related procedures.

Step-by-step guidance on how to perform Radial Access. Review tools, techniques, pearls, and pitfalls on the BackTable Web App.
Step-by-step guidance on how to perform Uterine Fibroid Embolization. Review tools, techniques, pearls, and pitfalls on the BackTable Web App.
 

References

[1] Yoon J, Valenti D, Muchantef K, et al. Superior Hypogastric Nerve Block as Post-Uterine Artery Embolization Analgesia: A Randomized and Double-Blind Clinical Trial. Radiology. 2018;289(1):248-254.
[2] Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 2013;30(4):354-63.
[3] Rasuli P, Jolly EE, Hammond I, et al. Superior hypogastric nerve block for pain control in outpatient uterine artery embolization. J Vasc Interv Radiol. 2004;15(12):1423-9.

Join The Discussion

 

Demos

Demos are not yet available for this procedure.

Please check back soon.

 

Tools

Tools are not yet available for this procedure.

Please check back soon.

 

Literature

Literature is not yet available for this procedure.

Please check back soon.

 

Podcasts

Podcasts are not yet available for this procedure.

Please check back soon.

 

Blog Articles

Blog articles are not yet available for this procedure.

Please check back soon.