Post Vasectomy Pain Forum

Superior Hypogastic Plexus Block?

Has anyone tried this nerve block? I haven’t seen local Pain Management for several months, but when I last saw him, he suggested this as next step.

Seems like a real long shot (pun intended).

I just had a similar injection. Mine was ilioinguinal/iliohypogastric peripheral nerve block. I laid on my back and the injection site was sort of near where my thigh meets my groin. Dr. was saying how there is an artery, a vein, and the nerve that all run along next to each other and he had to do it by feel and didn’t use the fluoroscope. I told him to take as much time as he needed! The injection contained lidocaine and a steroid (dexamethasone). The lidocaine wore off later that day and the steroids are supposed to kick in after 2 or 3 days. Haven’t noticed any relief yet. I had this done on Thursday (2 days ago). The injection itself wasn’t too bad. Anyone on here going through chronic groin pain would have no problem with it. I didn’t receive any type of local or sedation for this injection. Did make me a little nervous when the nurse put her hands on my legs and started patting them, then right before the Dr. goes in with the needs, she tells me to go ahead and grit my teeth. Then there was the audible sigh of relief when the Dr. didn’t hit anything that bled. The sigh came from the Dr. I got the feeling that although they do a lot of injections and nerve blocks, this wasn’t one that they did routinely. I asked and they confirmed my suspicion. I’ll keep you posted if this works though.

Those blocks should be done by experienced people only by ultrasound guidance. Mine was done under this and i wouldn’t have it any other way. If its not done under ultrasound guidance your playing with fire by non experienced people. Reason being only people with experience know how much can go wrong. Eg bleeds, vein damage, nerve damage just to name a few. So yes i had one and did not much, wore off by a week. And steroids mixture made me sick to.

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If they use an aspirating syringe, it shouldn’t be a problem. I hit veins and arteries all the time. I don’t like it but it’s not the end of the world. I agree that it should be done under ultrasound. Not because it’s dangerous without it but simply because it’s hard to find.

I’m scheduled to have this block done. I had a second genitofemoral block that helped for two days but the pain has since returned. I’m doing the superior hypogastric plexus block but I’m considering denervation with Dr. P. Has anyone had this plexus block? Just curious. Trying to buy time until denervation appointment in August.

From 4/16 - 12/18, I received injections by 4 different docs, so my story gets a bit confusing.

Most of my injections were by Pain Management at the Cleveland Clinic. He did both injections and pulsed RF nerve ablations. Never really got any durable relief. I was later told by other doctors that Pain Management docs seem to pride themselves on how LITTLE agent they inject. I definitely experienced that. Pain Mgt. loved to tell me how he’s so good at finding the right spot he only needs a “spoonful.” When I wasn’t getting results, he offered the superior hypogastric plexus block, but I passed, mainly out of lack of confidence in him, not the procedure.

Dr. P., by contrast, does a “mega block.” He hits you with a lot of anesthetic and steroid. I was battered and bruised each time but got much more durable relief from his approach, especially the last two in 2018 when he added botox.

I also saw a peripheral nerve surgeon in Baltimore. He did US-guided diagnostic blocks (anesthetic only) in office himself. He used A LOT of anesthetic. Zero benefit from II/IH block but great benefit from GF block. That session confirmed for me my problem was GF, something I could never fully feel confident of given local Pain Mgt. approach.

Came back and saw a local peripheral nerve surgeon who had me see a radiologist for a GF block. Same experience. He used WAY more agent and that block took my “1” pain scale pain (since it was 2-3 months after Dr. P’s mega block) to a “0”.

I’ve gone the block route to a certain extent as well. 1st GF block reduced pain by about 50%. We decided a second one might help reinforce the first one. It reduced pain by about 75% for two days then all of the pain came back as though I never had a block done at all. I’m also starting to get a lot of sympathetically mediated pain in my pelvis that was never present before. My hope is that this hypogastric block will temper the pelvic pain, maybe help with the testicle pain, while I contemplate my next move.

I can relate entirely. Sounds like a good plan. When my relapse started in 2016 (my first bout of PVPS was 2005-06 but resolved from reversal in mid-2006), it was all testicular. A few months later, it moved to the perineum. It hurt so badly there that I barely felt the testicular pain. Ended up with blocks in the pudendal region that resolved that pain, but they side-tracked me for 6 months.

Good luck. Sounds like you’re taking a logical approach. This isn’t easy to resolve.