Anaesthesia and Intensive Care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona, Ancona, Italy.
Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Acta Anaesthesiol Scand. 2022 Sep;66(8):1003-1008. doi: 10.1111/aas.14110. Epub 2022 Jul 11.
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.
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.
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.
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.
髂腹下神经外侧皮支（LCBIN）阻滞联合股外侧皮神经、臀上神经和肋下神经阻滞已被证明可为髋关节置换术切口提供完全的麻醉覆盖。已有人描述了这些神经的超声引导选择性神经阻滞的成功方法，但 LCBIN 除外。本尸体研究的目的是确定 LCBIN 的位置，为超声引导神经阻滞方法提供解剖学基础。此外，我们旨在评估使用超声引导神经阻滞方法后注射染料的扩散情况。
在 27 具成人尸体解剖中，双侧评估 LCBIN 及其与髂嵴（IC）的关系。在 2 具尸体的双侧，将超声换能器横向放置在 IC 上方，并向尾侧或头侧移动以识别 LCBIN。将一根针以平面内方式插入，并注入 3ml 含亚甲蓝的溶液，然后通过解剖确认。
从髂前上棘到 LCBIN 穿过 IC 的点的平均距离为 9.74±0.84cm。从神经穿过腹外斜肌腱膜的点到穿过 IC 的点的平均距离为 0.59±0.77cm。使用超声可以在 4 侧中的 3 侧轻松观察到神经。但是，在所有情况下，神经都被染色。
本研究表明，LCBIN 具有恒定的位置，在明确的解剖空间中易于超声可视化。因此，超声引导的 LCBIN 阻滞可能是盲目注射技术的替代方法。
