Vermeylen Kris, Van Aken David, Versyck Barbara, Casaer Sari, Bleys Ronald, Bracke Peter, Groen Gerbrand
Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium.
Department of Anaesthesia, Department of Radiology, AZ Klina, Brasschaat, Belgium.
BJA Open. 2023 Feb 15;5:100127. doi: 10.1016/j.bjao.2023.100127. eCollection 2023 Mar.
Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed.
We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients.
The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1).
We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology.
多种区域麻醉方法用于腰前丛分支，已被证明在髋关节手术中提供镇痛有效。然而，一些患者仍会经历明显的髋部后方残留疼痛，这归因于髋关节的后方神经供应。这不仅表明前路方法可能并不总是能提供足够的疼痛缓解，还提示需要阻滞供应关节囊后部区域的主要神经。
我们介绍一种超声引导技术，用于阻滞供应髋关节后关节囊的所有主要神经。通过超声成像、数字化横断面解剖和尸体研究确定了最佳目标区域，发现其位于臀深部间隙。此外，对两名患者进行了这种关节囊后深部臀肌阻滞评估。
在尸体中观察到染料在臀大肌深部、股方肌和梨状肌之间扩散，与超声检查过程中的推测位置相符。它包括了供应髋关节后关节囊的所有主要神经，即臀上神经、股方肌神经和坐骨神经。在应用这种关节囊后深部臀肌阻滞的两名患者中，疼痛均显著减轻（数字评分量表：从4降至1和从7降至1）。
我们提出了一种成功的超声引导技术，靶向臀深部间隙以阻滞供应髋关节后关节囊的所有主要神经。这种关节囊后深部臀肌阻滞可作为髋关节手术中的一种辅助阻滞方法，在慢性髋关节病变中也可能发挥作用。
