Technique of Inferior Hypogastric Block

Multiple approaches, such as lateral, prone, and lithotomy have been described (Figure 9-4.5).3 The most frequently used approach is the prone position. The sacrococcygeal area is prepped and draped in a sterile manner. The entry site, just under the tip of the coccyx, is anesthetized with lidocaine 0.5% using a 25-gauge needle. A 22-gauge, 3.5-in spinal needle is bent into a C shape (commercial C shape 22-gauge, 3.5-in spinal needles are also available). At the site of entry, just under the coccyx, the needle is advanced in a semicircular manner under fluoroscopy (lateral view) until the top of the needle is just anterior to the sacrococ-

Figure 9-4.3. AP view of superior hypogastric block.
Figure 9-4.4. Anatomy of ganglion impar. (Reprinted from Raj PP, Lou L, Erdine S, et al. Radiographic Imaging for Regional Anesthesia and Pain Management,p 238,Copy-right 2003, with permission from Elsevier.)
Figure 9-4.5. Lateral view of inferior hypogastric block.

cygeal junction. After a negative blood aspiration, a radio-opaque dye is injected (1-2mL) and the spread is viewed both in AP and lateral views. There should be a smooth contrast of the dye in the retroperitoneum between the sacrococcygeal region and the rectal bubble. After a negative blood aspiration, a total of 12 to 15mL of bupivacaine

0.375. is injected with intermittent aspirations.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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