• Po-Chou Liliang, Chao-Ming Hung, Kang Lu, and Han-Jung Chen.
• E-Da Hospital, I-Shou University, Neurosurgery Kaohsiung, Taiwan.
• Pain Physician. 2018 Jul 1; 21 (4): E341-E345.

BackgroundA superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5.ObjectiveWe report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle.Study DesignA technical note describing interventional procedures.SettingThe neurosurgery department of a cancer hospital.MethodsThe patient was placed in the prone position with a pillow beneath the iliac crest to facilitate opening of the intervertebral disc. The entry point for the needle was 7-8 cm to the left of the midline of the L45 level. The spinal needle was slightly advanced caudally toward the L5-S1 disc and at a 40° angle from the vertical plane. Using lateral fluoroscopic control, the needle was advanced beneath the inferior aspect of the facet joint. After entering the disc, the needle was then advanced until it passed the anterior annulus fibrosus of the L5S1 disc. After verifying adequate position using contrast, 3 mL of 75% ethanol was injected for neurolysis.ResultsDuring the follow-up, the patient reported reduction of pain in the lower abdomen and quality of life was significantly improved.LimitationsSample size; no placebo control.ConclusionAlthough different approaches exist, we prefer the posterolateral transdiscal approach for superior hypogastric plexus block and neurolysis using a single needle. This technique is a valuable alternative.Key WordsSuperior hypogastric plexus neurolysis, transdiscal approach, cancer pain.

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