Table of Contents
ISRN Anesthesiology
Volume 2012 (2012), Article ID 686082, 5 pages
http://dx.doi.org/10.5402/2012/686082
Research Article

Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus

1Department of Anesthesia and Pain Medicine, University of Washington, Seattle, WA 98195-6540, USA
2One Orthopedic Place, St. Augustine, FL 32086, USA
3Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest 1085, Hungary

Received 13 August 2012; Accepted 6 September 2012

Academic Editors: J. P. Estebe and D. Karakaya

Copyright © 2012 A. Stogicza et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.