{
  "abstract": "Background and Aims Nutcracker syndrome is a rare vascular condition, leading to chronic abdominal and pelvic pain due to venous congestion often refractory to conventional treatments. The presence of Factor V Leiden mutation, a genetic disorder that increases the risk of venous thrombosis, complicates clinical management by elevating thrombotic risk. Chronic pelvic pain is a challenging clinical problem with multifactorial etiology, often underdiagnosed, can have mechanical, inflammatory or neuropathic origin. The superior hypogastric plexus block targets sympathetic nerve fibers transmitting pelvic visceral pain. It provides long-lasting pain relief in various pelvic pain syndromes, including cancer-related and nonmalignant causes, with a safety profile when fluoroscopic guidance is used. This study aims to describe the experience and outcomes of a fluoroscopy-guided neurolytic block of the right superior hypogastric plexus in a patient with Nutcracker syndrome and Factor V Leiden mutation, focusing on analgesic efficacy and safety in the context of increased thrombotic risk.Methods A case report of a patient with confirmed Nutcracker syndrome and Factor V Leiden mutation, presenting refractory chronic pelvic pain. After multidisciplinary evaluation, a right superior hypogastric plexus block was performed under fluoroscopic guidance at the L4-L5 level with intravenous sedation. Contrast confirmed retroperitoneal needle placement, followed by injection of 2% lidocaine (160 mg/8 mL), 6% phenol (0.4 mL), and dexamethasone (8 mg/2 mL). Hemodynamic changes, bleeding, and pain (via numerical rating scale) were monitored perioperatively.Results The patient reported significant pain reduction (from 8/10 to 3/10 on the NRS at one month), reduced analgesic requirements, and no thrombotic or procedural complications during three-month follow-up. The block was well-tolerated with no adverse events.Abstract P045 Figure 1First approach L4-L5 levelAbstract P045 Figure 2Security profile by contrast locationAbstract P045 Figure 3Infiltration of medication and controlConclusions This case supports the superior hypogastric plexus neurolysis as a safe and effective therapeutic option for refractory pelvic pain in patients with Nutcracker syndrome and Factor V Leiden mutation expanding the armamentarium of regional anesthesia techniques in challenging clinical scenarios.",
  "authors": [
    {
      "affiliations": [
        "Pain Clinic, Hospital Geneal De Mexico Dr. Eduardo Liceaga, Mexico City, Mexico"
      ],
      "name": "Jose Luis Soto Najera"
    },
    {
      "affiliations": [
        "Pain Clinic, Hospital Geneal De Mexico Dr. Eduardo Liceaga, Mexico City, Mexico"
      ],
      "name": "Zaida Berenice Castro Lopez"
    },
    {
      "affiliations": [
        "Pain Clinic, Hospital Geneal De Mexico Dr. Eduardo Liceaga, Mexico City, Mexico"
      ],
      "name": "Christian Geraldyne Escamilla Reyes"
    }
  ],
  "title": "P045 Neurolytic block of the right superior hypogastric plexus in a patient with nutcracker syndrome at a tertiary care hospital",
  "uid": "ce193d0b-73e5-561e-9979-7bc5f613356e"
}