Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: A prospective randomized study

CONTEXT: The classic posterior approach to superior hypogastric plexus block (SHPB) is sometimes hindered by the iliac crest or a prominent transverse process of L5. The computed tomography (CT) – guided anterior approach might overcome these difficulties. AIMS: This prospective, comparative, randomized study was aimed to compare the CT guided anterior approach versus the classic posterior approach. SETTINGS AND DESIGN: Controlled randomized study. MATERIALS AND METHODS: A total of 30 patients with chronic pelvic cancer pain were randomized into either classic or CT groups where classic posterior approach or CT guided anterior approach were done, respectively. Visual analog score, daily analgesic morphine consumed and patient satisfaction were assessed just before the procedure, then, after 24 h, 1 week and monthly for 2 months after the procedure. Duration of the procedure was also recorded. Adverse effects associated with the procedure were closely observed and recorded. STATISTICAL ANALYSIS USED: Student's t-test was used for comparison between groups. RESULTS: Visual analog scale and morphine consumption decreased significantly in both groups at the measured times after the block compared with the baseline in the same group with no significant difference between both groups. The procedure was carried out in significantly shorter duration in the CT group than that in the classic group. The mean patient satisfaction scale increased significantly in both groups at the measured times after the block compared with the baseline in the same group. The patients in the CT groups were significantly more satisfied than those in classic group from day one after the procedure until the end of the study. CONCLUSIONS: The CT guided approach for SHPB is easier, faster, safer and more effective, with less side-effects than the classic approach.