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Dong Eon Moon - One of the best experts on this subject based on the ideXlab platform.
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A New Technique for Inferior Hypogastric Plexus Block: A Coccygeal Transverse Approach -A Case Report-
The Korean journal of pain, 2012Co-Authors: Hong Seok Choi, Young Hoon Kim, Jung Woo Han, Dong Eon MoonAbstract:Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior Hypogastric Plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior Hypogastric Plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior Hypogastric Plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior Hypogastric Plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior Hypogastric Plexus. Thus, we report a patient who was successfully given inferior Hypogastric Plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.
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A New Technique for Inferior Hypogastric Plexus Block: A Coccygeal Transverse Approach
2012Co-Authors: Hong Seok Choi, Young Hoon Kim, Jung Woo Han, Dong Eon MoonAbstract:Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior Hypogastric Plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior Hypogastric Plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior Hypogastric Plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior Hypogastric Plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior Hypogastric Plexus. Thus, we report a patient who was successfully given inferior Hypogastric Plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera. (Korean J Pain 2012; 25: 38-42)
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transdiscal superior Hypogastric Plexus block for postparaplegic pelvic pain
The Korean Journal of Pain, 1994Co-Authors: Dong Eon Moon, Mee Kyung Choi, Jae Hyun Suh, Sung Nyeun KimAbstract:Both pelvic pain associated with cancer and chronic benign conditions may be alleviated by blocking the superior Hypogastric Plexus. Traditional bilateral placement of needles is the appropriate technique for the patient with pelvic pain due to the bilateral distribution of the disease as well as allowing for individual difference of pelvic cavity. However the technique is a very difficult procedure and painful for the paient. However we have performed transdiscal superior Hypogastric Plexus neurolysis free of complication.
Marco C. Deruiter - One of the best experts on this subject based on the ideXlab platform.
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careful dissection of the distal ureter is highly important in nerve sparing radical pelvic surgery a 3d reconstruction and immunohistochemical characterization of the vesical Plexus
International Journal of Gynecological Cancer, 2016Co-Authors: Anne C. Kraima, Gemma G. Kenter, Marloes G.m. Derks, Noeska N. Smit, Cornelis J.h. Van De Velde, Marco C. DeruiterAbstract:Objective Radical hysterectomy with pelvic lymphadenectomy (RHL) is the preferred treatment for early-stage cervical cancer. Although oncological outcome is good with regard to recurrence and survival rates, it is well known that RHL might result in postoperative bladder impairments due to autonomic nerve disruption. The pelvic autonomic network has been extensively studied, but the anatomy of nerve fibers branching off the inferior Hypogastric Plexus to innervate the bladder is less known. Besides, the pathogenesis of bladder dysfunction after RHL is multifactorial but remains unclear. We studied the 3-dimensional anatomy and neuroanatomical composition of the vesical Plexus and describe implications for RHL. Materials and Methods Six female adult cadaveric pelvises were macroscopically dissected. Additionally, a series of 10 female fetal pelvises (embryonic age, 10–22 weeks) was studied. Paraffin-embedded blocks were transversely sliced in 8-μm sections. (Immuno) histological analysis was performed with hematoxylin and eosin, azan, and antibodies against S-100 (Schwann cells), tyrosine hydroxylase (postganglionic sympathetic fibers), and vasoactive intestinal peptide (postganglionic parasympathetic fibers). The results were 3-dimensionally visualized. Results The vesical Plexus formed a group of nerve fibers branching off the ventral part of the inferior Hypogastric Plexus to innervate the bladder. In all adult and fetal specimens, the vesical Plexus was closely related to the distal ureter and located in both the superficial and deep layers of the vesicouterine ligament. Efferent nerve fibers belonging to the vesical Plexus predominantly expressed tyrosine hydroxylase and little vasoactive intestinal peptide. Conclusions The vesical Plexus is located in both layers of the vesicouterine ligament and has a very close relationship with the distal ureter. Complete mobilization of the ureter in RHL might cause bladder dysfunction due to sympathetic and parasympathetic denervation. Hence, the distal ureter should be regarded as a risk zone in which the vesical Plexus can be damaged.
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Careful Dissection of the Distal Ureter Is Highly Important in Nerve-sparing Radical Pelvic Surgery: A 3D Reconstruction and Immunohistochemical Characterization of the Vesical Plexus.
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2016Co-Authors: Anne C. Kraima, Gemma G. Kenter, Marloes G.m. Derks, Noeska N. Smit, Cornelis J.h. Van De Velde, Marco C. DeruiterAbstract:Radical hysterectomy with pelvic lymphadenectomy (RHL) is the preferred treatment for early-stage cervical cancer. Although oncological outcome is good with regard to recurrence and survival rates, it is well known that RHL might result in postoperative bladder impairments due to autonomic nerve disruption. The pelvic autonomic network has been extensively studied, but the anatomy of nerve fibers branching off the inferior Hypogastric Plexus to innervate the bladder is less known. Besides, the pathogenesis of bladder dysfunction after RHL is multifactorial but remains unclear. We studied the 3-dimensional anatomy and neuroanatomical composition of the vesical Plexus and describe implications for RHL. Six female adult cadaveric pelvises were macroscopically dissected. Additionally, a series of 10 female fetal pelvises (embryonic age, 10-22 weeks) was studied. Paraffin-embedded blocks were transversely sliced in 8-μm sections. (Immuno) histological analysis was performed with hematoxylin and eosin, azan, and antibodies against S-100 (Schwann cells), tyrosine hydroxylase (postganglionic sympathetic fibers), and vasoactive intestinal peptide (postganglionic parasympathetic fibers). The results were 3-dimensionally visualized. The vesical Plexus formed a group of nerve fibers branching off the ventral part of the inferior Hypogastric Plexus to innervate the bladder. In all adult and fetal specimens, the vesical Plexus was closely related to the distal ureter and located in both the superficial and deep layers of the vesicouterine ligament. Efferent nerve fibers belonging to the vesical Plexus predominantly expressed tyrosine hydroxylase and little vasoactive intestinal peptide. The vesical Plexus is located in both layers of the vesicouterine ligament and has a very close relationship with the distal ureter. Complete mobilization of the ureter in RHL might cause bladder dysfunction due to sympathetic and parasympathetic denervation. Hence, the distal ureter should be regarded as a risk zone in which the vesical Plexus can be damaged.
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A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2001Co-Authors: J. B. Trimbos, Cornelis P. Maas, Marco C. Deruiter, Alexander A.w. Peters, Gemma G. KenterAbstract:Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve Plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the Hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior Hypogastric Plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior Hypogastric Plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.
Tuncay Çolak - One of the best experts on this subject based on the ideXlab platform.
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Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies.
The Clinical journal of pain, 2020Co-Authors: Hande Gurbuz Aytuluk, Ahmet Kale, Bahar Sarıibrahim Astepe, Gulfem Basol, Canan Balci, Tuncay ÇolakAbstract:OBJECTIVE To evaluate the efficacy of intraoperative superior Hypogastric Plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. MATERIALS AND METHODS A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). RESULTS There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P
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superior Hypogastric Plexus blocks for postoperative pain management in abdominal hysterectomies
The Clinical Journal of Pain, 2020Co-Authors: Hande Gurbuz Aytuluk, Ahmet Kale, Bahar Sarıibrahim Astepe, Gulfem Basol, Canan Balci, Tuncay ÇolakAbstract:OBJECTIVE To evaluate the efficacy of intraoperative superior Hypogastric Plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. MATERIALS AND METHODS A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). RESULTS There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9 min; P<0.05). All visual analogue scale score assessments were found to be statistically significantly lower in the SHP group (P<0.05). No complications related to the SHP blocks were observed. CONCLUSIONS Intraoperative SHP blocks in abdominal hysterectomies appear to be promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single SHP blocks provide adequate pain relief and reduce analgesic consumption, these blocks might have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations.
Sung Nyeun Kim - One of the best experts on this subject based on the ideXlab platform.
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transdiscal superior Hypogastric Plexus block for postparaplegic pelvic pain
The Korean Journal of Pain, 1994Co-Authors: Dong Eon Moon, Mee Kyung Choi, Jae Hyun Suh, Sung Nyeun KimAbstract:Both pelvic pain associated with cancer and chronic benign conditions may be alleviated by blocking the superior Hypogastric Plexus. Traditional bilateral placement of needles is the appropriate technique for the patient with pelvic pain due to the bilateral distribution of the disease as well as allowing for individual difference of pelvic cavity. However the technique is a very difficult procedure and painful for the paient. However we have performed transdiscal superior Hypogastric Plexus neurolysis free of complication.
Ribeiro, Sady M - One of the best experts on this subject based on the ideXlab platform.
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¿El bloqueo del plexo hipogástrico superior es eficaz en el tratamiento del dolor pélvico crónico?
Sociedade Brasileira de Anestesiologia, 2005Co-Authors: Schmidt, André P, Schmidt, Sérgio R G, Ribeiro, Sady MAbstract:JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo hipogástrico tem sido apresentado como uma alternativa segura e eficaz no tratamento de pacientes portadores de dor pélvica crônica. Os estudos publicados e disponíveis no MedLine, abordando este tema, foram incluídos e analisados nesta revisão. CONTEÚDO: Alguns estudos documentaram a eficácia do bloqueio do plexo hipogástrico superior em reduzir a intensidade da dor e o consumo de opióides, principalmente em pacientes com câncer. No entanto, os estudos apresentam falhas em seus métodos ou desenhos. CONCLUSÕES: Novos estudos prospectivos melhor conduzidos ainda são necessários para ratificar a efetividade do bloqueio do plexo hipogástrico no alívio de condições dolorosas pélvicas. Esses estudos devem possuir critérios de inclusão mais rigorosos, seguimento mais prolongado, avaliação de outros sintomas e da qualidade de vida antes e após o procedimento. O bloqueio do plexo hipogástrico superior deve ser recomendado como uma alternativa e não como terapêutica principal.BACKGROUND AND OBJECTIVES: Hypograstric Plexus block has been considered a safe and effective alternative for treat patients with chronic pelvic pain. Published studies available at MedLine on the subject were included and evaluated in this review. CONTENTS: Some studies have documented superior Hypogastric Plexus block effectiveness in relieving pain and decreasing opioid consumption, mainly in cancer patients. However, studies had failures in method or design. CONCLUSIONS: New prospective and better-designed studies are still needed to confirm the effectiveness of Hypogastric Plexus block in relieving pelvic pain. These studies shall have stricter inclusion criteria, longer follow-up, and evaluation of other symptoms and quality of life before and after the procedure. Superior Hypogastric Plexus block should be recommended as alternative and not as primary therapy.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo hipogástrico ha sido presentado como una alternativa segura y eficaz en el tratamiento de pacientes portadores de dolor pélvico crónico. Los estudios publicados y disponibles en el MedLine, abordando este tema, fueron incluidos y analizados en esta revisión. CONTENIDO: Algunos estudios documentaron la eficacia del bloqueo del plexo hipogástrico superior en reducir la intensidad del dolor y el consumo de opioides, principalmente en pacientes con cáncer. Sin embargo, los estudios presentan fallas en sus métodos o dibujos. CONCLUSIONES: Aún son necesarios nuevos estudios prospectivos y mejor conducidos, para poder ratificar la efectividad del bloqueo del plexo hipogástrico en el alivio de condiciones dolorosas pélvicas. Esos estudios deben poseer criterios de inclusión más rigurosos, seguimiento más prolongado, evaluación de otros síntomas y de la calidad de vida antes y después del procedimiento. El bloqueo del plexo hipogástrico superior debe ser recomendado como una alternativa y no como terapéutica principal