64517 Injection, anesthetic agent; superior hypogastric plexus

Name of the Procedure:

Injection, anesthetic agent; superior hypogastric plexus

Summary

The procedure involves injecting an anesthetic agent near the superior hypogastric plexus, a network of nerves in the pelvis. This injection is performed to provide pain relief, particularly in the lower abdomen, pelvis, or surrounding areas.

Purpose

The procedure addresses chronic pain conditions, especially those in the lower abdomen and pelvis. The main goal is to interrupt pain signals being transmitted by the superior hypogastric plexus, providing significant and often immediate pain relief to the patient.

Indications

• Chronic pelvic pain
• Pain from cancer involving pelvic organs
• Endometriosis-related pain
• Pain following pelvic surgeries
• Interstitial cystitis

Patient criteria:

• Failed conservative pain management approaches
• Diagnostic confirmation of pain originating from the pelvic region

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Medication review and adjustment, particularly blood thinners.
• Pre-procedure imaging, such as MRI or CT scans, to identify the exact location of the plexus.
• Allergy check for anesthetic agents.

Procedure Description

1. Patient lies on their stomach or back on the procedure table.
2. Use of fluoroscopy or CT imaging for precise needle placement.
3. Local anesthesia to numb the skin above the insertion site.
4. A thin needle is inserted through the skin, guided to the superior hypogastric plexus.
5. Anesthetic agent is injected once the needle is confirmed in the correct location.
6. Needle is then carefully withdrawn, and the site is cleaned and dressed.

Tools and equipment:

• Fluoroscopy or CT scanner
• Sterile needles and syringes
• Local anesthetic

Anesthesia:

• Local anesthesia at the insertion site.

Duration

The procedure typically takes about 30 minutes to 1 hour, including imaging and placement time.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped with imaging technology.

Personnel

• Pain specialist or anesthesiologist
• Radiologist or technician for imaging guidance
• Nurses for patient preparation and monitoring

Risks and Complications

• Bleeding or bruising at the injection site
• Infection
• Nerve damage
• Allergic reaction to the anesthetic
• Temporary increase in pain

Benefits

• Significant reduction or complete relief of pelvic or lower abdominal pain.
• Improved quality of life, allowing for better daily functioning.
• Relief may be immediate and last from weeks to months.

Recovery

• Monitoring for a few hours post-procedure for any adverse reactions.
• Rest for the remainder of the day.
• Avoid driving or operating machinery for 24 hours.
• Follow-up appointment to assess pain relief and plan further treatment if needed.

Alternatives

• Oral or intravenous pain medications
• Physical therapy
• Nerve blocks or other forms of nerve stimulation
• Pelvic floor rehabilitation

Pros and cons:

• Injection is minimally invasive with quick results compared to prolonged medication use or major surgery.
• Other treatments may not provide as immediate or prolonged pain relief.

Patient Experience

During the procedure, patients may feel pressure or mild discomfort when the needle is inserted. Post-procedure, patients might experience soreness at the injection site that resolves within a day or two. Pain relief is typically experienced shortly after the injection, and pain management techniques, including over-the-counter analgesics, can help with any residual soreness.