Skip to main content

Advertisement

SpringerLink
Log in

A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain

  • Chronic Pain Medicine (O Viswanath, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain.

Recent Findings

Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6 months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50–70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol.

Summary

CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain Lippincott Williams and Wilkins. 2019;160:19–27.

  2. Speer LM, Mushkbar S, Erbele T. Chronic pelvic pain in women. Am Fam Physician. 2016;93(5):380–7.

    PubMed  Google Scholar 

  3. Yosef A, Ahmed AG, Al-Hussaini T, Abdellah MS, Cua G, Bedaiwy MA. Chronic pelvic pain: pathogenesis and validated assessment. Middle East Fertil Soc Jl Middle East Fertility Society. 2016;21:205–21.

  4. Jones MR, Urits I, Wolf J, Corrigan D, Colburn L, Peterson E, et al. Drug-induced peripheral neuropathy, a narrative review. Curr Clin Pharmacol. 2019.

  5. Tu FF, Beaumont JL. Outpatient laparoscopy for abdominal and pelvic pain in the United States 1994 through 1996. Am J Obstet Gynecol. 2006:699–703.

  6. Van Den Beuken-Van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag Elsevier Inc. 2016;51:1070–1090.e9.

  7. Ayorinde AA, Bhattacharya S, Druce KL, Jones GT, Macfarlane GJ. Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study. Eur J Pain. 2017;21(3):445–55.

    Article  CAS  PubMed  Google Scholar 

  8. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. Br Med J BMJ Publishing Group. 2006;332:749–51.

  9. Gokyildiz S, Beji NK, Avcibay B, Ozgunen FT. Risk factors for chronic pelvic pain: hospital-based case-control study from Turkey. Int J Urol Nurs. 2014;8(3):144–50.

    Article  Google Scholar 

  10. Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol. 2013;64(3):431–9.

    Article  PubMed  Google Scholar 

  11. Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, et al. Prevalence of endometriosis during abdominal or laparoscopic hysterectomy for chronic pelvic pain. Obstet Gynecol Lippincott Williams and Wilkins. 2016:1045–53.

  12. Howard FM. Chronic pelvic pain. Obstet Gynecol Elsevier Inc. 2003;101:594–611.

  13. Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, et al. A comprehensive review of the diagnosis, treatment, and management of urologic chronic pelvic pain syndrome. Curr Pain Headache Rep NLM (Medline). 2020;24:27.

  14. Wozniak S. Chronic pelvic pain. Ann Agric Environ Med. 2016;23(2):223–6.

    Article  CAS  PubMed  Google Scholar 

  15. Max M. World Health Organization cancer pain relief program: network news. J Pain Symptom Manag. 1986;1:178–9.

    Article  Google Scholar 

  16. World Health Organisation (WHO). WHO’s pain ladder: World Health Organisation; 2012.

  17. Yang J, Bauer BA, Wahner-Roedler DL, Chon TY, Xiao L. The modified WHO analgesic ladder: is it appropriate for chronic non-cancer pain? J Pain Res. 2020.

  18. Hsu ES. Medication overuse in chronic pain. Curr Pain Headache Rep. 2017;21.

  19. • Vissers KCP, Besse K, Wagemans M, Zuurmond W, Giezeman MJMM, Lataster A, Mekhail N, Burton AW, van Kleef M, Huygen FJPM. Pain in patients with cancer. In: Evidence-Based Interventional Pain Medicine: According to Clinical Diagnoses. 2011. Guidelines set forth by the American Society of Interventional Pain Physicians guiding the use of opioids in chronic non-cancer pain, based on systematic and narrative reviews as well as individual studies.

  20. Hasoon J, Berger AA, Urits I, Orhurhu V, Viswanath O, Aner M. Spinal cord stimulation for the treatment of chronic pelvic pain after Tarlov cyst surgery in a 66-year-old woman: a case report. Case Rep Women’s Heal. 2020;25.

  21. Trescot AM, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006.

  22. Christo PJ, Mazloomdoost D. Interventional pain treatments for cancer pain. Ann N Y Acad Sci. 2008.

  23. Minson FP, Assis FD, Vanetti TK, Sardá Junior J, Mateus WP. Del Giglio A. Interventional procedures for cancer pain management. Sao Paulo: Einstein; 2012.

    Google Scholar 

  24. Brogan S, Junkins S. Interventional therapies for the management of cancer pain. J Support Oncol. 2010.

  25. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007.

  26. •• Tay W, Ho KY. The role of interventional therapies in cancer pain management. Ann Acad Med Singap. 2009; Plancarte et al. descrived their fluoroscopic (classical) approach to superior hypogastric plexus block in 1990. They described 70% pain reduction in their prospective trial of 28 patients.

  27. Eisenberg E, Marinangeli F, Birkhahn J, Paladini A, Varassi G. Time to modify the WHO analgesic ladder? Pain Clin Updat. 2005.

  28. Urits I, Ostling PS, Novitch MB, Burns JC, Charipova K, Gress KL, et al. Truncal regional nerve blocks in clinical anesthesia practice. Best Pract Res Bailliere Tindall Ltd. 2019;33:559–71.

  29. Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990.

  30. Markwell SJ. Physical therapy management of pelvi/perineal and perianal pain syndromes. World J Urol. 2001;19:194–9.

    Article  CAS  PubMed  Google Scholar 

  31. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction. J Sex Med. 2008;5:513–23.

    Article  PubMed  Google Scholar 

  32. Nickel JC, Mullins C, Tripp DA. Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2008;26:167–72.

    Article  PubMed  Google Scholar 

  33. Wang JK. Intrathecal morphine for intractable pain secondary to cancer of pelvic organs. Pain. 1985;21:99–102.

    Article  PubMed  Google Scholar 

  34. Hunter CW, Stovall B, Chen G, Carlson J, Levy R. Anatomy, pathophysiology and interventional therapies for chronic pelvic pain: a review. Pain Physician. 2018;21(2):147–67.

    Article  PubMed  Google Scholar 

  35. Urits I, Jones MR, Orhurhu V, Peck J, Corrigan D, Hubble A, et al. A comprehensive review of the celiac plexus block for the management of chronic abdominal pain [Internet]. Curr Pain Headache Rep Springer. 2020;24.

  36. Bhatnagar S, Gupta M. Evidence-based clinical practice guidelines for interventional pain management in cancer pain. Indian J Palliat Care. 2015;21(2):137–47.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kerr IG, Sone M, DeAngelis C, Iscoe N, MacKenzie R, Schueller T. Continuous narcotic infusion with patient-controlled analgesia for chronic cancer pain in outpatients. Ann Intern Med. 1988.

  38. Ballantyne JC, Carwood C, Gupta A, Bennett MI, Simpson KH, Dhandapani K, et al. Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev. 2005.

  39. Staats PS, Yearwood T, Charapata SG, Presley RW, Wallace MS, Byas-Smith M, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. J Am Med Assoc. 2004;291:63–70.

    Article  CAS  Google Scholar 

  40. Raffaeli W, Sarti D, Demartini L, Sotgiu A, Bonezzi C. Italian registry on long-term intrathecal ziconotide treatment. Pain Physician. 2011.

  41. Pope JE, Deer TR. Ziconotide: A clinical update and pharmacologic review. Expert Opin Pharmacother. 2013.

  42. Watson CPN. Bonica’s management of pain, 4th edition. J Pain Symptom Manag. 2010.

  43. Howell B, Lad SP, Grill WM, Glorioso JC. Evaluation of intradural stimulation efficiency and selectivity in a computational model of spinal cord stimulation. PLoS One. 2014.

  44. Bowersox SS, Gadbois T, Singh T, Pettus M, Wang YX, Luther RR. Selective N-type neuronal voltage-sensitive calcium channel blocker, SNX-111, produces spinal antinociception in rat models of acute, persistent and neuropathic pain. J Pharmacol Exp Ther. 1996.

  45. Deer TR, Levy R, Prager J, Buchser E, Burton A, Caraway D, et al. Polyanalgesic consensus conference-2012: recommendations to reduce morbidity and mortality in intrathecal drug delivery in the treatment of chronic pain. Neuromodulation. 2012;15(5):467–82.

    Article  PubMed  Google Scholar 

  46. Bottros MM, Christo PJ. Current perspectives on intrathecal drug delivery. J Pain Res. 2014;7:615–26.

    PubMed  PubMed Central  Google Scholar 

  47. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 2005-2012: An update with a focus on recent interventions. BMC Health Serv Res. 2014.

  48. Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA. Reframing the prevention strategies of the opioid crisis: focusing on prescription opioids, fentanyl, and heroin epidemic. Pain Physician. 2018;21(4):309–26.

    Article  PubMed  Google Scholar 

  49. • Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Trescot AM, Blank S, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American society of interventional pain physicians (ASIPP) guidelines. Pain Physician. 2017;20(2):S3–92 Description of technique and results for ultrasound-based blocks of the celiac, hypogastric and ganglion impar, including 18 patients undergoing superior hypogastric plexus block. The authors describe a significant reduction in pain in their patients.

    Article  PubMed  Google Scholar 

  50. Stoicea N, Costa A, Periel L, Uribe A, Weaver T, Bergese SD. Current perspectives on the opioid crisis in the US healthcare system. Medicine (Baltimore). 2019;98(20):e15425.

    Article  Google Scholar 

  51. Manchikanti L, Manchikanti KN, Kaye AD, Kaye AM, Hirsch JA. Challenges and concerns of persistent opioid use in cancer patients. Expert Rev Anticancer Ther. 2018.

  52. De Oliveira R, Dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain. 2004.

  53. Bhatnagar S, Khanna S, Roshni S, Goyal GN, Mishra S, Rana SPS, et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract. 2012;12:23–32.

    Article  PubMed  Google Scholar 

  54. Jain PN, Shrikhande SV, Myatra SN, Sareen R. Neurolytic celiac plexus block: a better alternative to opioid treatment in upper abdominal malignancies: an Indian experience. J Pain Palliat Care Pharmacother. 2005.

  55. Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943–53.

    Article  CAS  PubMed  Google Scholar 

  56. Lee M, Silverman S, Hansen H, Patel V, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14:145–61.

    Article  PubMed  Google Scholar 

  57. Eid S, Iwanaga J, Chapman JR, Oskouian RJ, Loukas M, Tubbs RS. Superior hypogastric plexus and its surgical implications during spine surgery: A Review. World Neurosur. 2018.

  58. Petersohn JD. Sympathetic neural blockade. Pain Proced Clin Pract. 2011.

  59. Watkins RG, Watkins RG. Superior hypogastric sympathetic plexus. Surgical Approaches to the Spine: In; 2003.

    Book  Google Scholar 

  60. Lee RB, Stone K, Magelssen D, Belts RP, Benson WL. Presacral neurectomy for chronic pelvic pain. Obstet Gynecol. 1986.

  61. Freier A. Pelvic neurectomy in gynecology. Obstet Gynecol. 1965.

  62. Johnson RM, McGuire EJ. Urogenital complications of anterior approaches to the lumbar spine. Clin Orthop Relat Res. 1981.

  63. Benzon H, Fishman S, Liu S, Cohen SP, Raja SN. Essentials of pain medicine. Essentials Pain Med. 2011.

  64. Aytuluk HG, Kale A, Astepe BS, Basol G, Balci C, Colak T. Superior hypogastric plexus blocks for postoperative pain management in abdominal hysterectomies. Clin J Pain. 2020.

  65. de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993.

  66. Huang L, Tao F, Wang Z, Wan H, Qu P, Zheng H. Combined neurolytic block of celiac and superior hypogastric plexuses for incapacitating upper abdominal cancer pain. J BUON. 2014.

  67. Liu WC, Flamer D. Case report: Tenesmus and the role of superior hypogastric plexus blocks. Palliat Med. 2019;33:392–5.

    Article  PubMed  Google Scholar 

  68. Rosenberg SK, Tewari R, Boswell MV, Thompson GA, Seftel AD. Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med. 1998;23:618–20.

    Article  CAS  PubMed  Google Scholar 

  69. BONICA JJ. The management of pain of malignant disease with nerve blocks. Anesthesiology. 1954;15:280–301.

    Article  CAS  PubMed  Google Scholar 

  70. •• Yoon SY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med. 2018; Rocha et al. described a prospective trial assessing the classic approach with 10% aqueous phenol injection and showed significant, long-lasting pain reduction in their cohort.

  71. Nicholson B. Differential diagnosis: nociceptive and neuropathic pain. Am J Manag Care. 2006.

  72. Trimble IR, Morrison S. Treatment of intractable pain of visceral origin. J Am Med Assoc. 1952;148:1184.

    Article  CAS  PubMed  Google Scholar 

  73. • Gofeld M, Shankar H, Benzon HT. Fluoroscopy and ultrasound-guided sympathetic blocks. Essentials Pain Med Elsevier. 2018:789–804.e2 Gamal et al. described a small RCT of the transdiscal versus classic approach and showed that both methods were safe and effective, though the transdiscal approach was also significantly faster to perform.

  74. Rocha A, Plancarte R, Natarén RGR, Carrera IHS, Pacheco VADLR, Hernández-Porras BC. Effectiveness of superior hypogastric plexus neurolysis for pelvic cancer pain. Pain Physician. 2020;23(2):203–8.

    PubMed  Google Scholar 

  75. Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 2005;206(3):277–81.

    Article  PubMed  Google Scholar 

  76. Erdine S, Yucel A, Celik M, Talu GK. Transdiscal approach for hypogastric plexus block. Reg Anesth Pain Med. 2003;28(4):304–8.

    CAS  PubMed  Google Scholar 

  77. •• Gamal G, Helaly M, Labib YM. Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006;22(6):544–7 Ghoneim et al. compared CT-guidance to the classical approach and against demonstrated safety and efficacy in both, with CT-guidance championing in terms of speed.

    Article  PubMed  Google Scholar 

  78. Mishra S, Bhatnagar S, Rana SPS, Khurana D, Thulkar S. Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Med (United States). 2013;14(6):837–42.

    Article  Google Scholar 

  79. Wechsler RJ, Maurer PM, Halpern EJ, Frank ED. Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology. 1995;196(1):103–6.

    Article  CAS  PubMed  Google Scholar 

  80. Yang X, You J, Tao S, Zheng X, Xie K, Huang B. Computed tomography-guided superior hypogastric plexus block for secondary dysmenorrhea in perimenopausal women. Med Sci Monit. 2018;24:5132–8.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Ghoneim AA, Mansour SM. Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: a prospective randomized study. Saudi J Anaesth. 2014;8(3):378–83.

    Article  PubMed  PubMed Central  Google Scholar 

  82. de Leon-Casasola OA. Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control. 2000;7(2):142–8.

    Article  PubMed  Google Scholar 

  83. Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Curr Pain Headache Rep Springer. 2010;14:261–7.

  84. Huang SH, Lu J, Gan HY, Li Y, Peng YG, Wang SK. Perineural dexamethasone does not enhance the analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2016;15(5):540–5.

    Article  PubMed  Google Scholar 

  85. Raj PP. Visceral pain. Agri. 2004;16(1):7–20.

    CAS  PubMed  Google Scholar 

  86. Plancarte R, De Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22(6):562–8.

    CAS  PubMed  Google Scholar 

  87. Amr YM, Makharita MY. Neurolytic sympathectomy in the management of cancer pain - time effect: a prospective, randomized multicenter study. J Pain Symptom Manag. 2014;48(5):944 956.e2.

    Article  Google Scholar 

  88. Koyyalagunta D, Engle MP, Yu J, Feng L, Novy DM. The effectiveness of alcohol versus phenol based splanchnic nerve neurolysis for the treatment of intra-abdominal cancer pain. Pain Physician. 2016;19(4):281–92.

    Article  PubMed  Google Scholar 

  89. Hou S, Novy D, Felice F, Koyyalagunta D. Efficacy of superior hypogastric plexus neurolysis for the treatment of cancer-related pelvic pain. Pain Med. 2019.

  90. Nagpal AS, Moody EL. Interventional management for pelvic pain. Phys Med Rehabil Clin N Am. 2017;28(3):621–46.

    Article  PubMed  Google Scholar 

  91. Choi JW, Kim WH, Lee CJ, Sim WS, Park S, Chae HB. The optimal approach for a superior hypogastric plexus block. Pain Pract. 2018;18(3):314–21.

    Article  PubMed  Google Scholar 

  92. Gofeld M, Lee C-W. Ultrasound-guided superior hypogastric plexus block: a cadaveric feasibility study with fluoroscopic confirmation. Pain Pract. 2017;17(2):192–6.

    Article  PubMed  Google Scholar 

  93. Srivastava M, Punj J. Management of cyclical pelvic pain by multiple ultrasound-guided superior hypogastric plexus blocks in a rare case of Mayer-Rokitansky-Küster-Hauser syndrome - a case series of three blocks in a patient. Intractable Rare Dis Res. 2019;8(4):271–4.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA

    Ivan Urits & Amnon A. Berger

  2. Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA

    Ivan Urits, Alan D. Kaye & Omar Viswanath

  3. Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA

    Ruben Schwartz & Jared Herman

  4. Department of Anesthesiology, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA

    David Lee, Alec M. Zamarripa, Kelly Habib & Omar Viswanath

  5. Creighton University School of Medicine – Phoenix Regional Campus, Phoenix, AZ, USA

    Christopher Lee

  6. Valley Pain Consultants – Envision Physician Services, Phoenix, AZ, USA

    Annabel Slovek & Omar Viswanath

  7. Pain Management Centers of America, Paducah, KY, USA

    Laxmaiah Manchikanti

  8. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

Authors
  1. Ivan Urits
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruben Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jared Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amnon A. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alec M. Zamarripa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Annabel Slovek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kelly Habib
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Laxmaiah Manchikanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alan D. Kaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Omar Viswanath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruben Schwartz.

Ethics declarations

Conflict of Interest

Ivan Urits, Ruben Schwartz, Jared Herman, Amnon A. Berger, David Lee, Alec M Zamarripa, Annabel Slovek, Laxmaiah Manchikanti, and Omar Viswanath declare no conflict of interest. Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Chronic Pain Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Urits, I., Schwartz, R., Herman, J. et al. A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain. Curr Pain Headache Rep 25, 13 (2021). https://doi.org/10.1007/s11916-020-00933-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-020-00933-0

Keywords

Search

Navigation