• The Korean Journal of Physiology
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• v.1 no.2
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• pp.135-140
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• 1967

It has been described that the pelvic and adjoining viscera are innervated by sympathetic fibers from the hypogastric nerve. However, the mode of action of the hypogastric nerve fibers on the organs is not fully understood. The present paper reviewed the results of investigations on the mode of action of the hypogastric nerve with an emphasis of the experimental results obtained by the author and author's associates. The evidences clarified that the hypogastric fibers to the distal colon are cholinergic, whereas the fibers to the uterus, seminal vesicle, seminal duct and urinary bladder are adrenergic.

• The Korean Journal of Pain
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• v.25 no.1
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• pp.38-42
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• 2012

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.108-112
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• 1992

Pain from pelvic cancer is very difficult to manage because it's vague ness and bilateral nature. Furthermore, nerve blocks in this area are dangerous because sensory afferent nerves from pelvic viscera are adjacent to nerves that regulate bowel and bladder control, and motor nerve of lower extremities'. Bilateral lumbar sympathectomy has been used for malignant pelvic pain with little risk of neurologic complication. However it is not a specific block for pelvic visceral pain, because the lumbar sympathetic chain does not innervate pelvic viscera in a direct manner. Therefore the potentials of lumbar sympathectomy for pelvic visceral pain are attributed to caudad diffusion of neurolytic agents to the smperior hypogastric plexus. I have experienced 3 cases of superior hypogastric plexus neurolysis per se without any significant complications.

• The Korean Journal of Pain
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• v.25 no.1
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• pp.43-46
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• 2012

The superior hypogastric plexus block (SHPB) is used for treating pelvic pain, especially in patients with gynecological malignancies. Various approaches to this procedure have been reported due to the anatomic obstacles of a high iliac crest or large transverse process of the $5^{th}$ lumbar vertebra. Here, we report a new technique of superior hypogastric plexus block using a unilateral single-needle approach to block the bilateral superior hypogastric plexus with a Tuohy needle and epidural catheter. We have confidence that this new technique can be another option in performing the SHPB when the conventional bilateral approach is difficult to perform.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.219-222
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• 1996

Superior hypogastric plexus block is extensively recognized as a unique nerve block method for the treatment of low abdominal pain originating from organs of the pelvic area. This block is difficult to perform on older patients, especially those with osteophyte, as they will experience a high degree of pain with this technique. Therefore we reported trans-discal superior hypogastric plexus by method of approach needle through disc. This method is less painful to the patient as compared to bilateral approach; and easier to place the needle tip at precise and proper location.

• The Korean Journal of Physiology and Pharmacology
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• v.5 no.1
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• pp.99-105
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• 2001

It is well known that the inflammation of somatic tissues, bladder and colon can alter the sensitivity of primary afferents innervating these tissues. To see if uterine afferents also show altered sensitivity, we examined their responses to the algesic agent bradykinin before and after induction of uterine inflammation. Inflammation was induced by injecting the mustard oil into the uterine lumen of adult female rats. After induction of inflammation, the response latency to bradykinin did not change, but the duration and peak of the response and integrated impulse discharges during the response period increased significantly. Furthermore, after inflammation, the level of resting discharges of the afferents was much higher. These results are consistent with the idea that the inflammation can sensitize the uterine afferents.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.238-241
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• 1999

Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

• The Korean Journal of Pharmacology
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• v.10 no.1 s.15
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• pp.31-40
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• 1974

1. The authors investigated the effects of $PGE_1$ on the action of sympathomimetics in the vas deferens of guinea-pig, comparing with those in the rat vas deferens, and also the action of $PGE_1$ on the motility of nerve-free smooth muscle of chick amnion. 2. In the isolated guinea-pig vas deferens, the actions of phenylephrine and norepinephrine were much potentiated by pretreatment with $PGE_1$. Futher, in the isolated hypogastric nerve-vas deferens preparation of guinea-pig, effects of phenylephrine, norepinephrine and tyramine on the contractile response of vas to the hypogastric nerve stimulation and to the transmural stimulation were also augumented especially in tension by $PGE_1$-pretreatment. 3. In the isolated hypogastric nerve-vas preparation of rat, both contractile responses to hypogastric nerve and transmural stimulation were slowly reduced by treatment with $PGE_1$ and the potentiated effect of phenylephrine or norepinephrine was not observed in spite of pretreatment with $PGE_1$. 4. The actions of phenylephrine and norepinephrine on the denervated vas deferens of guinea-pig were also enhanced by $PGE_1$ as it were in the intact vas deferens, but there was no significant effect by $PGE_1$ on the action of norepinephrine in the denervated rat vas deferens. 5. $PGE_1$ in low concentration $(10^{-8}g/ml)$ did not affect the spontaneous motility of nerve-free smooth muscle of chick amnion ($9{\sim}11$ th day incubated chick), but in large concentration $(5{\times}10^{-8}g/ml)$ it caused irregular and slightly inhibitory movement. Pretreatment with $PGE_1$ on chick amnion did not exert any change on the action of phenylephrine applied. However, the stimulatory action of physostigmine on the chick amnion was a little antagonized by the low concentration of $PGE_1$. 6. It might be summarized that there is species difference between the actions of $PGE_1$ on the vas deferens of guinea-pig and that of rat, and the action of $PGE_1$ on the guinea-pig vas deferens might be mediated by the other mechanism rather than by direct action on the vas musculature.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.145-150
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• 1996

The purpose of this study was to evaluate and compare the effectiveness of ilioinguinal-hypogastric nerve blocks(IHNB) and caudal block in producing post-orchiopexy and post-heniorrhaphy analgesia in children. Forty consenting healthy children, ages 3~10yr, were randomly assigned to receive caudal bupitvacaine (0.125%, 0.5ml/kg), or IHNB bupivacaine (0.25%, 0.3 ml/kg). Blocks were performed following the induction of general anesthesia, be fore the operation. Pre-anesthetic medication in form of atropine 0.01 mg/kg, droperidol 0.05 mg/kg were given intramuscularly one hour before induction to 40 children. Children were induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously. Anesthesia was maintained with oxygen-nitrous oxide ($FiO_2$ 0.3) and ethrane. When the patients stabilized after induction. IHNB was done in the supine position and caudal block was done in the lateral position. The local anaesthetic was injected after negative aspiration. Postoperative pain was assessed with face pain rating scale (RPRS) at rest on discharge of recovery room, and 5 hours after discharge of recovery room, and the "red and white" visual analogue scale (VAS) at rest and mobilization from supine to sitting position on discharge of recovery room, and 5 hours after discharge of recovery room. Post-operative recovery was quiet and comfortable, without side effect. Relief of ain was complete in both IHNB group and caudal group. Surgeons, parents and recovery room personnel were satisfied. There were no surgical or anesthetic complications. In our study, the postpoerative pain scores were similar in both IHNB group and caudal group. IN conclusion, we found that both IHNB and caudal blocks before the start of surgery for orchiopexy & herniorrhaphy are safe and effective in controlling the postoperative pain of children.