Thus, the hypogastric nerve should be carefully identified by firstly separating the gap between sacrospinous ligament and rectum, exposing the intersection between ureter and uterine artery, pushing away the ureter, separating downward along the uterine artery and pulling the uterus to the symphysis pubis to expose the hypogastric nerve and branch.
In addition, invasion of the pelvic nerve by nidus may also cause pain.11 The nerves dominating pelvic cavity, including urinary bladder, rectum, uterus and upper end of vagina, are mainly hypogastric nerve and hypogastric nerve plexus formed by nervus visceralis from the sciatic plexus (s2-s4).
During the discussion which followed his presentation he pointed out that it is easy to see hypogastric nerve and there is a risk of damage.
Responding to a question Prof.Tiret said that hypogastric nerve can be damaged but the risk is very low if the procedure is done carefully.
Dr Bradley: In addition to patients with respiratory problems, is there another subset of patients for whom an epidural or superior hypogastric nerve block might warrant consideration?
A superior hypogastric nerve block or an epidural may be an appropriate intervention.
The peritoneum is divided anterior to the plane of the hypogastric nerves, and the division is taken superiorly in a plane just anterior to the aorta.
The key is to keep the hypogastric nerves always in sight and proceed inferiorly in a plane just anterior to the nerves.
The left ureter and hypogastric nerves
should be carefully exposed and protected.
Afferent innervation of the bladder, producing sensations of fullness leading to detrusor contraction, is conveyed by the pelvic and hypogastric nerves
, which contain myelinated (A) and unmyelinated (C) axons.The basis of transduction between bladder filling (mucosal stretch) and afferent activation is chemically based mediation.
The pelvic autonomic nerves, including the superior hypogastric nerves
, the autonomic branches of S2-S4 autonomic branches, and the pelvic autonomic nerve plexus were identified and preserved.
Then the needle WAS repositioned horizontally beneath the external oblique aponeuronesis and after negative aspiration 5ml of 0.5% bupivacaine WAS deposited in a fan shaped manner which blocks ILLI INGUINAL and ILLIO HYPOGASTRIC nerves