48 Superior Hypogastric Plexus Block
Placement
Anatomy
The superior hypogastric plexus is continuous with the intermesenteric plexus and is located retroperitoneally, caudad to the origin of the inferior mesenteric artery. It lies anterior to the lower part of the abdominal aorta, its bifurcation, and the middle sacral vessels; more specifically, it is anterior to the fourth and fifth lumbar vertebrae and the first sacral vertebra. The plexus is composed of a flattened band of intercommunicating nerve bundles that descend over the aortic bifurcation (Figs. 48-1 and 48-2). Broadening below, it divides into the right and left hypogastric nerves. In addition to its continuity with the intermesenteric plexus, the superior hypogastric plexus receives input from the lower two lumbar splanchnic nerves (Fig. 48-3). Figure 48-3 identifies with a red triangle a key concept in the superior hypogastric plexus nerve block. The red triangle highlights the anatomic window between the iliac crest, the L5 transverse process, and the L5-S1 vertebral bodies, which allows successful needle insertion.