Dumps Christian, Nothofer Stefanie, Weiss Manfred, Hoelz Wolfgang, Litz Rainer J, Bocher Robert, Kies Felicitas, Funk Richard, Heller Axel Rüdiger, Simon Philipp
Anesthesiology and Operative Intensive Care, Faculty of Medicine, University of Augsburg, Bavaria, Germany.
Department of Anesthesiology and Intensive Care Medicine, Medical Faculty Carl Gustav Carus, TU- Dresden, Saxony, Germany.
Local Reg Anesth. 2025 Aug 19;18:67-76. doi: 10.2147/LRA.S527808. eCollection 2025.
Substantial understanding of anatomic landmarks remains mandatory for regional anesthesia procedures of the lower limbs, even in times of ultrasound-guided techniques. Theoretically, applying a diagonal vector (DIVE) from the posterior superior iliac spine towards the spinous process of lumbar vertebra 3 leads to a higher error tolerance and closer nerve approximation when compared to Chayen's approach. The purpose of this study was to compare both techniques regarding clinical applicability, accuracy and risk profile.
Lumbar plexus block was performed bilaterally according to Chayen's technique and the DIVE method in embalmed bodies donated to science. The posterior medial half of the psoas major muscle was predefined as the puncture target area. Essential anatomical landmarks were labelled, photographed and a computer-aided analysis of the images was conducted. Both approaches were compared regarding the puncture success rate, spatial nerve approximation and complications such as vessel or kidney punctures.
Both techniques were applied bilaterally on 34 embalmed bodies (50% male, mean age ± standard deviation 82 ± 8 years, height 167 ± 10cm) and led to similar success rates of a psoas muscle hit (Chayen vs DIVE 86.3% vs 82.8%). DIVE punctures were more often localized in the medial third of the psoas (p<0.001), whereas the risk for vessel or kidney punctures was similar (p=0.473; p=0.367, respectively).
Punctures according to the DIVE method resulted in a higher puncture accuracy compared to Chayen's technique with comparable practicability and risk profile. When using the DIVE Block, a window for a successful puncture can be expected between a quarter and a third of the PSIS- L3SP distance.
即使在超声引导技术时代，对下肢区域麻醉手术而言，充分了解解剖标志仍必不可少。理论上，与查延（Chayen）法相比，从髂后上棘向第3腰椎棘突应用对角向量（DIVE）可导致更高的误差容忍度和更接近神经。本研究的目的是比较这两种技术在临床适用性、准确性和风险方面的情况。
在捐赠给科学事业的尸体上，按照查延技术和DIVE方法双侧进行腰丛阻滞。将腰大肌后内侧半部分预先定义为穿刺目标区域。标记并拍摄重要的解剖标志，然后对图像进行计算机辅助分析。比较两种方法在穿刺成功率、神经空间接近度以及血管或肾脏穿刺等并发症方面的情况。
两种技术均在34具尸体（50%为男性，平均年龄±标准差82±8岁，身高167±10厘米）上双侧应用，腰大肌穿刺成功率相似（查延法对DIVE法为86.3%对82.8%）。DIVE穿刺更常位于腰大肌内侧三分之一处（p<0.001），而血管或肾脏穿刺风险相似（分别为p=0.473；p=0.367）。
与查延技术相比，采用DIVE方法穿刺具有更高的准确性，且实用性和风险相当。使用DIVE阻滞时，预计在髂后上棘至第3腰椎棘突距离的四分之一到三分之一之间有成功穿刺的窗口。
