Interventional pain · London
Superior hypogastric plexus block, for pelvic cancer pain.
A day-case sympathetic block of the plexus that carries pain signals from the pelvic organs - done by an interventional pain consultant under fluoroscopy or CT, with a diagnostic block first and a neurolytic step only if it works.
Why patients choose us
- 01
A pain consultant who does neurolysis weekly
Not a general injection list. A named interventional pain consultant with a high volume of sympathetic blocks, in a unit set up for fluoroscopy or CT guidance.
- 02
Diagnostic first, neurolytic only if it works
A local-anaesthetic and steroid test block comes first. Only if you get over 50% relief do we proceed to phenol or ethanol neurolysis.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private superior hypogastric plexus block costs in London.
Indicative ranges across our London partner units. Send the letters and imaging and we quote firm figures across two or three options.
In short
Diagnostic block £2,400–£4,500. Neurolytic block £3,500–£6,500. Home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation and imaging review | £250–£450 | 30–45 min | 48 hours |
| Diagnostic block (local anaesthetic + steroid) | £2,400–£4,500 | 30–60 min | Same visit |
| Neurolytic block (phenol 6% or ethanol 50–100%) | £3,500–£6,500 | 45–75 min | Same visit |
| CT-guided block (complex anatomy or prior surgery) | £4,500–£7,500 | 60–90 min | Same visit |
| Ganglion impar block (perineal / coccyx pain) | £2,200–£4,200 | 30–45 min | Same visit |
| Follow-up review | £180–£300 | 20–30 min | 2 weeks |
Prices vary by unit, by which consultant does the case, by whether CT rather than fluoroscopy guidance is used, and by whether sedation is added. We come back with a firm quote within one working day.
The journey
From referral to relief - what happens, in order.
One team from first message to the neurolytic step, alongside your oncology and palliative-care team.
- 01
Before
You send us the letters and imaging
A short, confidential form. Oncology or gynaecology letters, staging scans, current analgesic ladder, and what you have already tried.
- 02
Before
We come back with a recommendation
Within one working day: whether a superior hypogastric plexus block fits, or whether a ganglion impar, coeliac plexus or intrathecal pump is the better call.
- 03
Before
We arrange the diagnostic block
Usually within one to two weeks. Anticoagulants are reviewed, coagulation is checked, and consent is taken for the diagnostic and possible neurolytic step.
- 04
On the day
Arrival at the unit
Arrival, IV access and a chat with the consultant. Prone positioning on a fluoroscopy or CT table, with light sedation if you would like it.
- 05
On the day
The block itself
30 to 60 minutes. Bilateral posterior needle placement at L5 to S1, contrast confirmation, then 5 to 10 mL of agent per side.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a few hours. You will need someone to collect you if any sedation was used.
- 07
After
Response review and neurolytic step
Pain diary at 2 weeks. If you get over 50% relief from the diagnostic block, we schedule the neurolytic block with phenol 6% or ethanol 50 to 100%.
Typical end-to-end: 1–2 weeks to diagnostic block. Response review at 2 weeks. Neurolysis effect: 3–6 months.
When it helps
When a superior hypogastric block fits - and when it does not.
The presentations we see most, and the red flags that mean a two-week-wait pathway rather than a private nerve block.
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Pelvic cancer pain (cervical, uterine, ovarian)
Deep midline pelvic pain from gynaecological malignancy - the strongest indication, with a large evidence base.
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Prostate and bladder cancer pain
Advanced prostate or bladder cancer with visceral pelvic pain that persists despite opioids and hormonal therapy.
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Rectal and anorectal cancer pain
Rectal or recto-sigmoid tumours causing deep pelvic pain - often combined with a ganglion impar block if pain is perineal.
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Endometriosis pain, refractory to surgery
Chronic pelvic pain from endometriosis that has failed medical and surgical management - a diagnostic block first.
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Chronic prostatitis and pelvic pain syndrome
Chronic non-bacterial prostatitis or male chronic pelvic pain syndrome, once infection and structural causes are excluded.
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Interstitial cystitis with pelvic pain
Bladder pain syndrome where the pain component dominates - used alongside bladder-directed treatment, not instead of it.
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Post-surgical pelvic pain
Persistent pain after hysterectomy, prostatectomy or pelvic exenteration where neuropathic and visceral drivers overlap.
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Red flag: undiagnosed pelvic pain
New pelvic pain without a diagnosis needs a two-week-wait pathway to exclude malignancy - not a private nerve block.
Procedure options
The block is a family of techniques - and other options sit beside it.
What each option involves, and how it fits alongside a coeliac plexus block, a ganglion impar block or an intrathecal drug pump.
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Diagnostic block (LA + steroid)
Bupivacaine with a small dose of steroid, bilateral at L5 to S1. Confirms the plexus is the pain generator and predicts response to neurolysis.
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Neurolytic block with phenol 6%
The standard neurolytic agent for cancer pain. Less painful on injection than ethanol and gives 3 to 6 months of relief per treatment.
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Neurolytic block with ethanol 50–100%
An alternative agent, sometimes preferred where phenol is contraindicated. Burning on injection is mitigated with local anaesthetic pre-dose.
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Fluoroscopy-guided posterior approach
The workhorse - prone position, oblique needles under fluoroscopy to the anterolateral L5 to S1 vertebral body, contrast confirmation before injection.
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CT-guided approach
Reserved for altered anatomy - prior spinal surgery, vertebral collapse, retroperitoneal disease - where fluoroscopy alone is not enough.
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Transdiscal single-needle approach
A midline needle through the L5 to S1 disc. Fewer needle passes, but a small risk of discitis - only in selected patients.
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Ganglion impar block (related)
A separate block at the sacrococcygeal junction for perineal, coccyx and lower rectal pain - often combined with a superior hypogastric block.
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Intrathecal drug pump (when blocks fail)
For patients with a life expectancy over 3 months who no longer respond to blocks, an implanted pump delivers opioid and local anaesthetic directly to the spinal cord.
Evidence and London centres
A small evidence base, but a consistent one.
De Leon-Casasola and later case series show a 60 to 70% reduction in opioid requirements for pelvic cancer pain after neurolysis. Randomised trials are limited, but every published series shows meaningful benefit in well-selected patients.
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Royal Marsden Private Care
Palliative pain and cancer nerve blocks
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Kings College Hospital Private Care
Interventional pain in complex oncology
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HCA The Wellington Hospital
Pain Management Programme with fluoroscopy
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London Bridge Hospital
Private pain service, day-case blocks
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Cleveland Clinic London
Multidisciplinary pain and palliative care
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Imperial Private Healthcare, Charing Cross
Pelvic pain and cancer pain pathway
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Interventional pain consultants with high volumes of sympathetic neurolytic blocks
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Fluoroscopy and CT guidance available in the same unit, with contrast confirmation
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Integrated palliative-care and oncology pathways so blocks sit inside a treatment plan
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Escalation pathways to intrathecal drug delivery when neurolytic blocks are no longer enough
Safety and recovery
What to expect afterwards - honestly.
Serious complications are uncommon with image guidance. The things worth planning are sedation, the anticoagulation review, and the two-week response review.
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Light sedation, not general anaesthesia
Most blocks are done awake with local anaesthetic and light sedation. This lets you report paraesthesia, which helps the consultant avoid nerve roots.
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Nerve root injury is uncommon
Under 1% with fluoroscopy or CT and contrast confirmation. Transient leg pain or numbness settles within days; permanent injury is very rare.
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Ureter and vessel puncture
The ureter, iliac vessels and lumbar vessels are close to the needle path. Contrast confirmation and image guidance make significant injury uncommon.
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Retroperitoneal bleeding
Small retroperitoneal haematoma is possible, particularly on anticoagulants. Coagulation and medication list are reviewed and adjusted before the procedure.
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Sexual and bladder dysfunction
Bilateral sympathectomy can cause retrograde ejaculation in men and transient bladder or bowel change. Discussed honestly, particularly in non-cancer indications.
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Duration of relief - 3 to 6 months
A single neurolytic block typically gives 3 to 6 months of meaningful relief. Blocks can be repeated safely; opioid requirements often fall by 40 to 70%.
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Discitis after transdiscal approach
A small but real risk with the transdiscal single-needle route. Prophylactic antibiotics and strict asepsis are used; we reserve this route for selected cases.
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When to call us after discharge
New leg weakness, difficulty passing urine, uncontrolled pain, fever, or expanding back or flank pain - call the unit or go to A&E the same day.
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Integration with palliative care
A block is part of a plan, not a replacement for it. Opioids, adjuvants, hormonal or oncological treatments and palliative-care support continue alongside.
Reading your procedure note
Your block note in four parts. Read the last one first.
Whichever approach was used, the note the consultant sends you keeps to the same shape.
A quiet reminder
Pain-medicine language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your follow-up, just ask.
- 01 Header
Indication, agent and needle route
Diagnostic or neurolytic, agent used (bupivacaine, phenol 6% or ethanol), needle approach (bilateral posterior, transdiscal or CT-guided) and volume per side.
- 02 Technique
Contrast spread and confirmation
Where the contrast tracked, whether spread was bilateral and confined to the pre-vertebral plane, and any adjustments made during the procedure.
- 03 Findings
Immediate response and complications
Pain score before and after, any intra-procedure paraesthesia, transient hypotension, and the consultants judgement on the technical result.
- 04 Impression
Follow-up plan and next step
Read this first: when to review the pain diary, whether to proceed to neurolysis, and when repeat blocks or intrathecal drug delivery would be considered.
Recognised by major UK insurers
Cover for interventional pain blocks varies by insurer - usually funded for cancer pain when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about superior hypogastric plexus blocks.
Quick answers on how the block works, how long it lasts, and how it sits alongside your oncology and palliative-care team.
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What is a superior hypogastric plexus block?
The superior hypogastric plexus is a sympathetic nerve network sitting in front of the L5 to S1 vertebral bodies. It carries most of the pain signals from the pelvic organs - uterus, ovaries, cervix, prostate, bladder, rectum. A block places local anaesthetic (diagnostic) or a neurolytic agent such as phenol or ethanol (therapeutic) at the plexus under fluoroscopy or CT guidance, interrupting those pain signals.
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Who is a good candidate?
Adults with pelvic visceral pain from cervical, uterine, ovarian, prostate, bladder or rectal cancer, and selected non-cancer patients with refractory endometriosis pain, chronic prostatitis and pelvic pain syndrome, interstitial cystitis with a dominant pain component, or post-surgical pelvic pain. A diagnostic block with local anaesthetic comes first - only patients with over 50% relief go on to neurolysis.
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How long does the relief last?
A diagnostic block gives hours to a few days of relief. A neurolytic block with phenol 6% or ethanol 50 to 100% typically gives 3 to 6 months. Blocks can be safely repeated, and most cancer patients see opioid requirements fall by 40 to 70% after a successful neurolysis.
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What is the difference between this and a coeliac plexus block?
A coeliac plexus block targets pain from the upper abdomen - pancreas, liver, upper GI - at the T12 to L1 level. A superior hypogastric plexus block targets pain from the pelvic organs at L5 to S1. For perineal, coccyx or lower rectal pain a ganglion impar block at the sacrococcygeal junction is used, sometimes combined with a superior hypogastric block.
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How much does it cost privately in the UK?
Roughly £2,400 to £4,500 for a diagnostic block, and £3,500 to £6,500 for a neurolytic block with phenol or ethanol. CT-guided blocks in complex anatomy are £4,500 to £7,500. A ganglion impar block is £2,200 to £4,200. Consultation and imaging review is £250 to £450. We confirm firm figures within one working day.
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What are the risks?
The main risks are nerve root injury (under 1%), transient hypotension, ureter or vessel puncture, retroperitoneal bleeding, and bladder or bowel dysfunction from bilateral sympathectomy. Retrograde ejaculation is possible in men and is discussed before consent. Serious complications are uncommon with image guidance and contrast confirmation, but the balance sits differently for a cancer patient and a young non-cancer patient - which is why the diagnostic block is done first.
Talk to us about pelvic pain
Pain from pelvic cancer or refractory pelvic pain? We will match you with the right consultant in London.
Send us your letters and imaging. Within one working day we come back with two or three named consultants, a firm quote, and an honest read on whether a superior hypogastric plexus block, a ganglion impar block or an intrathecal pump fits your case.
Related treatments and conditions
Looking for something else?
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Coeliac plexus block
Sympathetic block for upper-abdominal cancer pain from pancreas, liver and stomach.
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Stellate ganglion block
Sympathetic block in the neck for head, neck and upper-limb pain syndromes.
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Ganglion impar block
Sympathetic block at the sacrococcygeal junction for perineal and coccyx pain.
Learn more -
Intrathecal drug pump
Implanted pump delivering opioid and local anaesthetic to the spinal cord.
Learn more -
Pelvic cancer
Gynaecological, urological and colorectal pelvic malignancy - staging and treatment.
Learn more -
Endometriosis
Refractory chronic pelvic pain - medical, surgical and interventional pain options.
Learn more