BACKGROUND: The lateral cutaneous branch of the iliohypogastric nerve (LCBIN) block combined with the lateral femoral cutaneous, superior cluneal and subcostal nerve blocks has been shown to provide complete anaesthetic coverage for the incisions used for hip arthroplasty. Successful ultrasound-guided selective nerve blocks have been described for these nerves, except for the LCBIN. The objective of this cadaveric study was to determine the position of the LCBIN in order to provide the anatomical basis for an ultrasound-guided nerve block approach. Furthermore, we aimed to evaluate the spread of injected dye after using the ultrasound-guided nerve block approach. METHODS: The LCBIN and its relationship with iliac crest (IC) was assessed bilaterally in 27 adult cadaveric dissections. Bilaterally, in two cadavers, an ultrasound transducer was applied transversely above the IC and moved in caudal or cranial direction to identify the LCBIN. A needle was inserted in-plane and 3 ml of a solution with methylene blue was injected and confirmed by dissection. RESULTS: The mean distance from the anterior superior iliac spine to the point where the LCBIN crossed the IC was 9.74 ± 0.84 cm. The mean distance from the point where the nerve pierced the aponeurosis of the external oblique muscle to the point where it crossed the IC was 0.59 ± 0.77 cm. The nerve was easily visualised in 3 out of 4 sides using ultrasound. However, the nerve was coloured in all cases. CONCLUSION: The present study showed that the LCBIN has a constant location and is sonographically easy visualized in a well-defined anatomical space. Thus, the ultrasound guided LCBIN block may be an alternative to the blind injection technique.

Anaesthesia and Intensive Care of Transplantation and Major Surgery Department of Emergency Ospedali Riuniti di Ancona Ancona Italy

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czech Republic

Zobrazit více v PubMed

Jamieson RW, Swigart LL, Anson BJ. Points of parietal perforation of the ilioinguinal and iliohypogastric nerves in relation to optimal sites for local anaesthesia. Q Bull Northwest Univ Med Sch. 1952;26:22-26.

Mandelkow H, Loeweneck H. The iliohypogastric and ilioinguinal nerves. Distribution in the abdominal wall, danger areas in surgical incisions in the inguinal and pubic regions and reflected visceral pain in their dermatomes. Surg Radiol Anat. 1988;10:145-149.

Klaassen Z, Marshall E, Tubbs RS, Louis RG Jr, Wartmann CT, Loukas M. Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 2011;24:454-461.

Anloague PA, Huijbregts P. Anatomical variations of the lumbar plexus: a descriptive anatomy study with proposed clinical implications. J Man Manip Ther. 2009;17:107-114.

Reinpold W, Schroeder AD, Schroeder M, Berger C, Rohr M, Wehrenberg U. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia. 2015;19:539-548.

Maigne JY, Maigne R, Guerin-Surville R. Anatomic study of the lateral cutaneous rami of the subcostal and iliohypogastric nerves. Surg Radial Anat. 1986;8:25-26.

de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Ek F. Bloc des branches perforantes late' rales des nerfs sous-costal et ilio-hypogastrique. Ann Fr Anesth Reanim. 1997;16:982-984.

de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med. 2000;25:158-162.

Nielsen TD, Moriggl B, Barckman J, et al. Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: a randomised trial. Acta Anaesthesiol Scand. 2019;63:101-110.

Hebbard PD. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Can J Anaesth. 2009;56:618-620.

Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38:289-299.

Sites BD, Taenzer AH, Herrick MD, et al. Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry. Reg Anesth Pain Med. 2012;37:478-482.

Nielsen TD, Moriggl B, Barckman J, et al. The lateral femoral cutaneous nerve: description of the sensory Territory and a novel ultrasound-guided nerve block technique. Reg Anesth Pain Med. 2018;43:357-366.

Nielsen TD, Moriggl B, Barckman J, et al. Randomized trial of ultrasound-guided superior cluneal nerve block. Reg Anesth Pain Med. 2019;44:772-780.

Ke X, Li J, Liu Y, Wu X, Mei W. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports. BMC Anesthesiol. 2017;17:86.

de Leeuw MA, Dertinger JA, Hulshoff L, et al. The efficacy of levobupivacaine, ropivacaine, and bupivacaine for combined psoas compartment-sciatic nerve block in patients undergoing total hip arthroplasty. Pain Pract. 2008;8:241-247.

Ho AMH, Karmakar MK. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis. Can J Anesth. 2002;49:946-950.

Buckenmaier CC, Xenos JS, Nilsen SM. Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty. J Arthroplasty. 2002;17:499-502.

Chen L, Liu J, Yang J, Zhang Y, Liu Y. Combined fascia iliaca and sciatic nerve block for hip surgery in the presence of severe ankylosing spondylitis: a case-based literature review. Reg Anesth Pain Med. 2016;41:158-163.

Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-417.

Davies A, Crossley A, Harper M, O'Loughlin E. Lateral cutaneous femoral nerve blockade limited skin incision coverage in hip arthroplasty. Anaesth Intensive Care. 2014;42:625-630.

Nersesjan M, Hägi-Pedersen D, Andersen JH, et al. Sensory distribution of the lateral femoral cutaneous nerve block-a randomised, blinded trial. Acta Anaesthesiol Scand. 2018;62:863-873.