64681 Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus

Name of the Procedure:

Destruction by Neurolytic Agent (Neurolysis), Superior Hypogastric Plexus Block

Summary

Destruction by neurolytic agent involves using chemical agents to destroy nerve tissue, specifically targeting the superior hypogastric plexus. This procedure helps alleviate chronic pelvic pain by disrupting nerve signals.

Purpose

This procedure aims to treat chronic pelvic pain which may arise from various conditions such as cancer, endometriosis, or post-surgical pain. The goal is to provide long-lasting pain relief by disabling the pain-transmitting nerves in the superior hypogastric plexus.

Indications

• Chronic pelvic pain unresponsive to other treatments
• Cancer-related pelvic pain
• Pelvic pain due to endometriosis or post-surgical conditions
• Patients who have not found relief from medications or less invasive procedures

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medication, particularly blood thinners, may be necessary.
• Pre-procedural imaging studies, such as CT or MRI, may be required to accurately target the nerve plexus.

Procedure Description

1. The patient is positioned comfortably, usually lying face down or on their side.
2. Local anesthesia is administered to numb the skin and underlying tissues.
3. Using radiologic monitoring (such as fluoroscopy or CT), a needle is guided to the superior hypogastric plexus.
4. A neurolytic agent (such as alcohol or phenol) is injected to destroy the nerve tissue, thereby disrupting pain signals.
5. The needle is removed, and the injection site is cleaned and bandaged.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center equipped with radiologic monitoring facilities.

Personnel

• Interventional pain specialist or anesthesiologist
• Radiologic technologist
• Nursing staff

Risks and Complications

• Bleeding or infection at the injection site
• Temporary worsening of pain
• Nerve damage leading to weakness or numbness
• Allergic reaction to the neurolytic agent
• Rarely, complications related to radiologic monitoring (exposure to radiation)

Benefits

• Significant and potentially long-term reduction in pelvic pain
• Improved quality of life and ability to engage in daily activities
• Reduced need for pain medications

Recovery

• Patients are usually observed for a short period post-procedure before being discharged.
• Mild discomfort or soreness at the injection site may occur.
• Most patients can resume normal activities within a day, but strenuous activities may need to be avoided for a few days.
• Follow-up appointments to assess pain relief and monitor any side effects.

Alternatives

• Medications (e.g., analgesics, anti-inflammatory drugs)
• Less invasive nerve blocks or injections
• Physical therapy
• Surgical interventions (e.g., nerve ablation)
• Pros and cons vary; less invasive options may provide temporary relief, while surgical options carry higher risks.

Patient Experience

Patients may feel a brief stinging sensation from the local anesthesia and pressure as the needle is guided into place. Discomfort is generally minimal due to the local anesthesia. Post-procedure, some soreness at the injection site is expected, but pain management measures will be provided to ensure comfort.