Which is more effective for ovarian pain in a female patient, a hypogastric plexus block or a celiac plexus block?

Superior Hypogastric Plexus Block is the Appropriate Choice for Ovarian Pain

For ovarian pain specifically, a superior hypogastric plexus block is the correct intervention, not a celiac plexus block. The ovaries are innervated by the superior hypogastric plexus, making this the anatomically appropriate target for ovarian-related visceral pain 1.

Anatomical Basis for Block Selection

The critical distinction between these two blocks lies in their anatomical targets and pain distribution patterns:

Superior Hypogastric Plexus:

• Targets the bilateral retroperitoneal plexus at the L5-S1 vertebral level, anterior to the sacral promontory 1
• Specifically indicated for pelvic pain from lower abdominal and pelvic viscera, including the uterus and ovaries 1
• Also covers bladder, prostate, testes, descending and sigmoid colon, and rectum 1

Celiac Plexus:

• Targets upper abdominal viscera only 2
• Indicated specifically for pancreatic cancer and upper abdominal malignancies 2
• Does not provide innervation to pelvic structures including the ovaries 2

Clinical Decision Algorithm

When evaluating pelvic pain location:

• If pain involves the suprapubic region, lower abdomen, or deep pelvis (including ovaries): perform superior hypogastric plexus block 1
• If pain is localized to upper abdomen or pancreas: perform celiac plexus block 2
• If pain is localized to perineum, anus, or distal genitalia: perform ganglion impar block 1

Evidence for Superior Hypogastric Block in Pelvic Pain

Multiple studies support the use of superior hypogastric plexus block for chronic pelvic pain:

• CT-guided superior hypogastric plexus block in women with endometriosis and pelvic pain resulted in considerable to complete pain relief in the majority of cases 3
• The procedure is considered safe and effective for pelvic visceral pain, with a favorable risk-benefit ratio 4
• It serves as an adjuvant to decrease oral and parenteral analgesic requirements 1

Expected Outcomes and Duration

• Neurolytic blocks typically produce analgesia lasting 3-6 months 2, 1
• The block should be considered an adjuvant therapy rather than standalone treatment 1
• Best suited for patients with short life expectancy in cancer-related pain, though can be used for non-malignant chronic pelvic pain 2, 3

Critical Contraindications

Do not perform superior hypogastric plexus block if:

• Active infection at injection site 1
• Coagulopathy or bleeding disorders (must discontinue anticoagulants/antiplatelets appropriately) 2, 1
• Very short life expectancy (weeks) where benefit may not be realized 1

Important Caveats

• For patients with good prognosis, use caution with neurolytic agents as they can cause neuritis that may be more difficult to control than the original pain 2
• The procedure requires imaging guidance (CT or fluoroscopy) and should be performed by experienced interventional pain specialists 4, 3
• Consider this intervention when patients experience inadequate pain control despite pharmacologic therapy or cannot tolerate opioid titration due to side effects 2