Evaluation of Posteromedial Transdiscal Superior Hypogastric Block After Failure of the Classic Approach

Abstract

The iliac crest and L5 transverse process are potential barriers to proper needle placement in superior hypogastric plexus block (SHPB) for pelvic cancer pain. Several investigators report successful SHPB using a paramedian transdiscal approach. Another new single puncture approach, posteromedian transdiscal, has been described which can be performed with the patient in either lateral or prone position. Twenty-two patients were included in the study. Visual analog score, daily morphine consumption, duration of the procedure, side effects, and Quality of Life Questionnaire-C30 were recorded. The duration of the procedure was 21.4 ± 6.5 minutes. The mean visual analog score, daily morphine consumption, and Quality of Life Questionnaire-C30 score were significantly decreased. There was no neural injury, headache, discitis, or disc herniation. The posteromedian transdiscal approach to SHPB for cancer pain proved to be safe and reliable compared with the classic technique. No nerve or disc-related complications were noted.