Nerve block

[Babs RN]

My new pain guy mentioned doing a hypogastric plexus block--has anyone had this done? How do they do it? Has it worked for anyone? Thanks in advance--been a nurse for a while, never heard of this.

Barb

[Katrina]

I haven't had this done myself I hope someone here that has can answer you. Just as in pain cicumstances they block the message the bladder is sending to the brain. I hope this helps you.


:kiss:

[Dixiefireball]

i havent had it done either i pray that it helps you. please let us know how it works for you.

[Jim in San Antonio]

Barb,

Sorry if this is too long.

I’ve had three hypogastric plexus blocks (first in 1999; last in 2002). (My current urologist [top-notch] had never heard of them being used for urologic issues; most urologists haven’t.) Historically, the procedure was invented in the late 1980s for cancer pain,
( http://www.cancerpain.org/Html/Physicians/Articles/superior.html ), but they’re using it more for other things, including IC. Doesn’t work for everyone, but may be worth a try. (It looks like, from what I’ve seen in the medical literature, they “work” about half the time; but even those could be fairly temporary). They inject either a local anesthetic (like bupivacaine) or steroids, or both.

For my first block, when I asked about putting a line in for sedation, they said, "We can put it in later if you need it." The block was done by a resident who said he was only "assisting" the attending physician (who, as it turns out, was out in the hallway with his head barely peeking in). After screaming several times when the needle hit the periosteum around the spine, I asked why Dr “XX” couldn't do the procedure. This guy (he’s supposedly a “star” in medical circles, with a lot of “buzz” about him) then stepped in (he was kind of huffy since I'd interrupted his "training session") and got it done. This was all done without a smidgen of sedation. Other than a day of leg discomfort (from the resident inadvertently hitting the genitofemoral nerve), I didn’t have any negative effects afterwards. But it didn’t work either. Don’t let this experience I’m reporting here scare you away from it, because all you have to do is INSIST on sedation.

For my other two blocks, I went to a doc who had done a residency under the group mentioned above. (She said they had laughed at her when she went into private practice and told her, “Now you’ll actually have to pay attention to what your patients think.”) For the first (only had bupivacaine as the therapeutic agent), I had IV Diprovan (propofol) for sedation. Very fine stuff; my wife started laughing when she saw me in the recovery room, because I had a big smile on my face. I did get some major relief (unfortunately only for 15 days). During injection they had seen dye only on one side (they can see the placement by using fluoroscopy), so they turned me on my side to get it to spread to both sides.

For the last one (both bupivacaine and a steroid), they started me on Versed and finished with Diprovan. Unfortunately, that block didn’t help. The block is not without risk, but I do have confidence in my current anesthesiologist/pain medicine doc.

So, anyway, it could be worth considering (as long as they give you sedation…). Let me know if you have any other questions.

Jim

P.S.> My IC case is a bit complicated, with concurrent prostate cancer (which was removed). IC symptoms are manageable (Effexor, baclofen, self-hypnosis; one or two or all three, don’t know which for sure).

[Babs RN]

Thanks for the info Jim--you actually answered some of the tihings my logical ideas my nurse mind was considering but my fraidy cat gut keep sticking in. Great city San Antonio, by the way. Went to OBC at Fort Sam in the early 90's.

Thanks again,
Barb

[Trinka]

Barb,

I have had several of the hypo gastric plexus blocks done. The first one I had done about 5 years ago. I was awake during the procedure but given something for pain. They took two long needles and inserted them in my lower back by my spine to get to the nerves they needed to get to. When they did this they always hit my sciatic nerve and caused damage. I had to go to physical therapy for this but eventually it got straightened out.

It did work for me for a while but the medicine they injected in there wore off. They did a permanent block with phenol which was suppose to sever the nerve. It lasted for 9 months and then I started having problems again with my IC. I am really not sure what happened unless the pain signals from my bladder rerouted somehow.

After having failure of the interstim, I had the blocks done again last year. This doctor went in through my belly and it was less painful than the previous ones going in my back. The only problem is that I would only get relief for about 48 hrs. They couldn't do another permanent block because once it is done that is it. You can't sever nerves again.

I think that it is a easy procedure to get through compared to some of the other things us ICers have to go through.

I hope that this info helps. If you have any other questions, I would be happy to answer them.

Good Luck,
Trinka