A superior hypogastric plexus block (SHPB) is a type of injection. It’s used to diagnose and treat pain in the lower part of the abdomen and the pelvis.
Your brain sends information to the body through pathways known as nerves. Nerves also receive information from the body and send it to the proper regions of the brain. A nerve plexus is a place in the body where many different nerves intersect. Nerves that communicate some types of pain signals from the lower abdomen and pelvis pass through the superior hypogastric plexus on their way to the brain.
Your superior hypogastric plexus sits in front of the spine in the lower part of your back. Nerves from several parts of the lower abdomen and pelvis pass through this plexus. That includes nerves from the following organs:
- Bladder or urethra
- Lower intestines
- Uterus, ovaries, or vagina
- Prostate, testicles, or penis
During an SHPB, a healthcare provider will place needles in your back on both sides of the spine. He or she will move them to a position in front of the spine where the superior hypogastric plexus is located. Then he or she will inject medicine into the area to ease pain.
You might need an SHPB if you have pain in the lower abdomen or pelvis that stems from dysfunction or damage in the pelvic organs. Another name for pain from your organs is visceral pain. This type of pain is often constant and deep. It spreads out through the lower abdomen and pelvis rather than just in one particular spot.
For example, an SHPB might help your pain if you have:
- Ovarian, cervical, endometrial, or uterine cancer
- Prostate or colon cancer
- Bladder cancer
- Injury to the pelvis from surgery or radiation treatment
- Chronic low abdominal or pelvic pain
Your healthcare provider may use SHPB to diagnose the cause of your pain. He or she can do so by injecting numbing medicine (local anesthetic) in the area to see if your pain improves. The shot helps to pinpoint the pelvic organs as the source of pain. In other cases, SHPB can be used to treat your pain with injection of other medicine in the area.
SHPB is generally safe. Some possible risks of the procedure are:
- Temporary drop in blood pressure
- Damage to nearby nerves
- Damage to the spinal cord
- Damage to nearby organs
- Damage to nearby blood vessels
- Allergic reaction to the medicines
If you get steroid medicine in your injection, you may have side effects. These include temporary increases in blood sugar levels for 1 to 2 days, an allergic reaction, and flushing of your face. There is also a risk that the procedure will not ease your pain.
You may not be able to have the procedure if you have a high risk of bleeding or if you have an infection in the region of the injection. Your own risk may vary based on your age and other health problems. Before your procedure, talk with your healthcare provider about all your concerns.
You will need to go over your past health with your healthcare provider. Let him or her know if you have an infection, fever, or other recent health problems. If you use any blood-thinning medicines, check about special precautions you might need to take.
You should also discuss all your medicines with your healthcare provider. You may need to stop taking certain medicines a few days beforehand. Also be sure to tell your healthcare provider if you:
- Have any allergies
- Have had any problems with contrast dyes, past injection procedures, anesthesia, or other medicines
- Are pregnant or might be pregnant
Your healthcare provider may ask you not to eat or drink after midnight the night before the procedure. You may get medicine to help you relax during the SHPB. You should arrange to have someone drive you home afterward. Check with your healthcare provider about any other specific ways you should prepare.
Your exact procedure may differ. But general steps for an SHPB might include the following:
- You will lie on your stomach on a procedure table.
- You may get medicine to help you relax (sedation).
- During the procedure, your heart rate, blood pressure, and oxygen level will be watched. You may get extra oxygen by a mask or nasal tubing.
- The area of your lower back where you will have the injection will be cleaned.
- The healthcare provider will use medicine to numb the injection area. It may burn and sting a little. But it should last only a few seconds.
- The provider inserts two needles into your lower back, near each hip bone. He or she will move them to the correct position. He or she may use live X-rays, CT imaging, or ultrasound to help guide the needles.
- The provider injects a small amount of X-ray contrast dye through these needles to make sure they are in exactly the right spot.
- The provider injects medicine through the needles. He or she may use different types of medicines for different reasons. Numbing medicine may be needed to block pain signals. Steroid medicine may be needed to reduce inflammation. Sometimes the provider will use other medicines to temporarily damage the nerves. It stops them from transmitting pain. After the shot, you may feel a warm or burning sensation in the area.
You will likely be watched for 30 to 60 minutes after the procedure. Then you will need to have someone drive you home. You should not plan on doing anything strenuous or anything that requires your full attention for the rest of the day.
Ask your healthcare provider about any activity restrictions after the procedure. You should be able to eat and drink normally. Ask your healthcare provider if you should resume your normal medicines. Make sure to follow all your healthcare provider’s instructions for care.
It is common to have pain at the injection site for a day or two. Many people feel pain relief soon after the procedure. It might last a few hours, a few weeks, or longer depending on the medicines used.
You should call your healthcare provider if you have any of the following symptoms:
- Severe pain
- Weakness or numbness in the legs
- Signs of infection at the site of the injection. These include redness, swelling, and oozing.
Your healthcare provider can give you other specific instructions about what you should do and what you can expect after the SHPB. You will need to follow up with your healthcare provider to discuss the effects of the SHPB and make a plan for future treatment of your pain.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Cancer Pain Management, Up To Date
Moe, Jimmy, MD,Fraser, Marianne, MSN, RN