Nielsen Thomas Dahl, Moriggl Bernhard, Barckman Jeppe, Jensen Jan Mick, Kolsen-Petersen Jens Aage, Søballe Kjeld, Børglum Jens, Bendtsen Thomas Fichtner
Department of Anesthesiology, Aarhus Universitetshospital, Aarhus, Denmark.
Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria.
Reg Anesth Pain Med. 2019 May 6. doi: 10.1136/rapm-2018-100174.
The superior cluneal nerves originate from the dorsal rami of primarily the upper lumbar spinal nerves. The nerves cross the iliac spine to innervate the skin and subcutaneous tissue over the gluteal region. The nerves extend as far as the greater trochanter and the area of innervation may overlap anterolaterally with the iliohypogastric and the lateral femoral cutaneous (LFC) nerves. A selective ultrasound-guided nerve block technique of the superior cluneal nerves does not exist. A reliable nerve block technique may have application in the management of postoperative pain after hip surgery as well as other clinical conditions, for example, chronic lower back pain. In the present study, the primary aim was to describe a novel ultrasound-guided superior cluneal nerve block technique and to map the area of cutaneous anesthesia and its coverage of the hip surgery incisions.
The study was carried out as two separate investigations. First, dissection of 12 cadaver sides was conducted in order to test a novel superior cluneal nerve block technique. Second, this nerve block technique was applied in a randomized trial of 20 healthy volunteers. Initially, the LFC, the subcostal and the iliohypogastric nerves were blocked bilaterally. A transversalis fascia plane (TFP) block technique was used to block the iliohypogastric nerve. Subsequently, randomized, blinded superior cluneal nerve blocks were conducted with active block on one side and placebo block contralaterally.
Successful anesthesia after the superior cluneal nerve block was achieved in 18 of 20 active sides (90%). The area of anesthesia after all successful superior cluneal nerve blocks was adjacent and posterior to the area anesthetized by the combined TFP and subcostal nerve blocks. The addition of the superior cluneal nerve block significantly increased the anesthetic coverage of the various types of hip surgery incisions.
The novel ultrasound-guided nerve block technique reliably anesthetizes the superior cluneal nerves. It anesthetizes the skin posterior to the area innervated by the iliohypogastric and subcostal nerves. It improves the anesthetic coverage of incisions used for hip surgery. Among potential indications, this new nerve block may improve postoperative analgesia after hip surgery and may be useful as a diagnostic block for various chronic pain conditions. Clinical trials are mandated.
EudraCT, 2016-004541-82.
臀上皮神经主要起源于上腰段脊神经后支。这些神经跨过髂嵴，支配臀区的皮肤和皮下组织。神经延伸至大转子，其支配区域在髂前外侧可能与髂腹下神经和股外侧皮神经重叠。目前不存在选择性超声引导下臀上皮神经阻滞技术。一种可靠的神经阻滞技术可能在髋关节手术后疼痛管理以及其他临床情况（如慢性下腰痛）中具有应用价值。在本研究中，主要目的是描述一种新型超声引导下臀上皮神经阻滞技术，并绘制皮肤麻醉区域及其对髋关节手术切口的覆盖范围。
本研究作为两项独立调查进行。首先，解剖12侧尸体以测试一种新型臀上皮神经阻滞技术。其次，将该神经阻滞技术应用于20名健康志愿者的随机试验中。最初，双侧阻滞股外侧皮神经、肋下神经和髂腹下神经。采用腹横筋膜平面（TFP）阻滞技术阻滞髂腹下神经。随后，进行随机、盲法臀上皮神经阻滞，一侧为有效阻滞，对侧为安慰剂阻滞。
20个有效侧中有18个（90%）在臀上皮神经阻滞后成功实现麻醉。所有成功的臀上皮神经阻滞后的麻醉区域与TFP联合肋下神经阻滞麻醉区域相邻且在其后。添加臀上皮神经阻滞显著增加了各种类型髋关节手术切口的麻醉覆盖范围。
新型超声引导神经阻滞技术能可靠地麻醉臀上皮神经。它麻醉髂腹下神经和肋下神经支配区域后方的皮肤。它改善了髋关节手术切口的麻醉覆盖范围。在潜在适应证中，这种新的神经阻滞可能改善髋关节手术后的术后镇痛，并且可能作为各种慢性疼痛状况的诊断性阻滞。需要进行临床试验。
EudraCT，2016 - 004541 - 82。
