Bloqueo del plexo hipogástrico inferior

Una técnica nueva de bloqueo del plexo hipogástrico inferior: abordaje coccígeo transversal - informe de caso. A new technique for inferior hypogastric plexus block: a coccygeal transverse approach -a case report-. Choi HS, Kim YH, Han JW, Moon DE. Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. Korean J Pain. 2012 Jan;25(1):38-42. Epub 2012 Jan 2. Abstract Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera. http://pdf.medrang.co.kr/paper/pdf/Jkp/Jkp025-01-07.pdf    Bloqueo hipogástrico inferior: abordaje transacro  Inferior hypogastric plexus blockade: a transsacral approach. Schultz DM. Medical Advanced Pain Specialists, Minneapolis, MN 55433, USA.dschultz@painphysicians.com Pain Physician. 2007 Nov;10(6):757-63. Abstract BACKGROUND: Despite recent refinements in the technique of hypogastric plexus blockade, the lower pelvic organs and genitalia are innervated by fibers from the pre-sacral inferior hypogastric plexus and these fibers are not readily blocked using paravertebral or transdiscal approaches. DESIGN: Report of a technique to introduce a transsacral approach to blockade of the inferior hypogastric plexus. METHODS: A technique for performing inferior hypogastric plexus blockade by passing a spinal needle through the sacral foramen is described with 15 blocks in 11 patients. RESULTS: Fifteen inferior hypogastric plexus blocks were performed on 11 female patients who presented with chronic pelvic pain. Pelvic pain was decreased following 11 of the procedures with pre- and post-pain scores (SD) of 7.4 (2.3) and 5.0 (2.7), respectively (P < 0.05). There were no complications or unusual occurrences. CONCLUSIONS: This block can be performed safely and effectively if the interventionalist has a high degree of familiarity with sacral anatomy, refined needle steering technique, and expertise in fluoroscopy. Properly performed, transsacral blockade of the inferior hypogastric plexus is a safe technique for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera. http://www.painphysicianjournal.com/2007/november/2007;10;757-763.pdf

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org