Superior Hypogastric Plexus Block

Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director

Conditions Treated

Chronic pelvic pain, pelvic pain related to gynecologic, colorectal or bladder cancer, and pelvic pain that has not settled with other treatment.

Superior Hypogastric Plexus Block at a Glance

Type of procedure	Outpatient, image-guided (fluoroscopy)
Anesthesia	Local anesthetic at the skin; sedation can be arranged in advance
Time in the procedure room	About 30–45 minutes
Going home	Same day, after a short observation; with sedation, someone drives you home
Two versions	A short-acting test block, and a longer-lasting (neurolytic) block for selected patients
Where the evidence is strongest	Pelvic pain related to cancer — see the study table below
Repeatable	Yes; in the published series, some patients needed a second block[1] to reach full benefit

The Nerve Junction That Carries Pelvic Pain

The superior hypogastric plexus is a web of sympathetic nerve fibers that sits in front of the spine, at the ledge where the last lumbar vertebra meets the sacrum. The physicians who first described this block located their target as the sympathetic nerves lying anterior to the sacral promontory[2] — in plain terms, just in front of that bony ledge. Pain signals from the bladder, the lower bowel and the reproductive organs funnel through this junction on their way to the spinal cord, which is why medication placed at this one crossing point can affect pain arising from several pelvic organs at once.

A Test Block First, Then a Longer-Lasting One

The block is usually staged. The first injection contains only local anesthetic, and its purpose is narrow: to find out whether your pain actually travels through the superior hypogastric plexus. Relief while the anesthetic is working, even for a few hours, says yes. In the major published series, patients whose pain responded to a dilute-anesthetic test block went on to receive the longer-lasting neurolytic version one day later.[1]

The neurolytic version interrupts the same fibers for an extended period and is mainly offered to patients with cancer-related pelvic pain whose medications are no longer keeping up. You and your physician decide together whether that second stage makes sense in your case.

The Day of the Procedure

1. Positioning. You lie face down while the skin of the lower back is cleaned and numbed, with monitoring on for the whole visit.
2. Guidance. Fluoroscopic X-ray images locate the L5–S1 junction, where the plexus sits.
3. Needle placement. Needles are advanced toward the front of the spinal column under repeated imaging.
4. Confirming position. A small amount of contrast dye is injected and its spread is watched on the images before any medication is given.
5. The injection. The local anesthetic — or, where planned, the neurolytic agent — is delivered, the needles come out, and you go home after a short observation.

What the Published Studies Found

The published record on this block runs from its first description in 1990 to cohort studies in 2020. Most of that record comes from cancer centers.

1990 — first description, 28 patients	Sympathetically mediated pelvic pain was significantly reduced or eliminated in all cases,[2] with no serious complications reported.
1993 — 26 patients, cancer-related pain	69% reached satisfactory pain relief[3] after one or two neurolytic blocks, and opioid doses fell significantly in both response groups.
1997 — 227 patients, multicenter	79% responded to the test block; of those responders, 72% had satisfactory relief and opioid use fell by 43%.[1]
2020 — 180 patients over a decade	Success was 59.4% at one month and 48.8% at six months,[4] with a sustained reduction in pain scores.
2020 — 46 patients, MD Anderson	Average pain scores fell from 6.9 to 4.5[5] by the one-to-six-month follow-up, and adverse effects were mild.

Across the series, roughly half to three-quarters of patients reached a satisfactory result, and the strongest responses came in patients whose test block was positive first. Nearly every patient studied had cancer-related pain, so that is where the evidence for the neurolytic version is concentrated. For pelvic pain from other causes, the test block still has diagnostic value, and what follows it is decided case by case.

Risks and Side Effects

In the published series, both of the original cohorts reported no complications related to the block,[3] and the most recent one described adverse effects as mild and well tolerated.[5] The routine risks of any deep injection still apply — soreness at the needle sites for a day or two, and small risks of bleeding or infection. A neurolytic block carries additional considerations of its own, and your physician goes through them with you first. Tell the team about any blood thinners when the visit is scheduled.

Common Questions

Is this block only used for cancer pain?

No, though that is where the research is concentrated. The large published series enrolled patients with pelvic pain from gynecological, colorectal, or genitourinary cancer.[1] For long-standing pelvic pain from other causes, the short-acting test version can be part of a diagnostic work-up, and any further step follows from what it shows.

What does it mean if the relief wears off quickly?

A test block is expected to wear off. A clear response, even a brief one, tells your physician the pain is traveling through this plexus, and that finding guides the next step.

How is this different from a ganglion impar block?

Different target on the same nerve chain. The ganglion impar sits lower, in front of the tailbone, and covers the very lowest structures. The superior hypogastric plexus sits higher and gathers signals from more of the pelvic organs. Which one fits depends on where your pain is coming from.

Will one injection fix the pain permanently?

No single injection is presented as a permanent fix. In the studies above, relief from a neurolytic block was measured in months, and some patients needed a second block. The aim is a durable window of relief inside a broader plan, with the response tracked at follow-up.

References

Clinical sources for this page.

1. Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22(6):562–568. Back to first citation ↑
2. Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73(2):236–239. Back to first citation ↑
3. de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54(2):145–151. Back to first citation ↑
4. Rocha A, Plancarte R, Nataren RGR, Carrera IHS, Pacheco VALR, Hernandez-Porras BC. Effectiveness of Superior Hypogastric Plexus Neurolysis for Pelvic Cancer Pain. Pain Physician. 2020;23(2):203–208. Back to first citation ↑
5. Hou S, Novy D, Felice F, Koyyalagunta D. Efficacy of Superior Hypogastric Plexus Neurolysis for the Treatment of Cancer-Related Pelvic Pain. Pain Med. 2020;21(6):1255–1262. Back to first citation ↑