Article Text

Download PDFPDF
The Lateral Femoral Cutaneous Nerve: Description of the Sensory Territory and a Novel Ultrasound-Guided Nerve Block Technique
  1. Thomas D. Nielsen, MD*,
  2. Bernhard Moriggl, MD, PhD, FIACA,
  3. Jeppe Barckman, MD, PhD,
  4. Jens A. Kølsen-Petersen, MD, PhD*,
  5. Kjeld Søballe, MD, DMSc,
  6. Jens Børglum, MD, PhD§ and
  7. Thomas F. Bendtsen, MD, PhD*
  1. *Department of Anesthesiology, Aarhus University Hospital, Denmark
  2. Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Austria
  3. Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus
  4. §Department of Anesthesiology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
  1. Address correspondence to: Thomas F. Bendtsen, MD, PhD, Department of Anesthesiology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark (e-mail: tfb{at}dadlnet.dk).

Abstract

Background and Objectives Nerve blockade of the lateral femoral cutaneous (LFC) nerve provides some analgesia after hip surgery. However, knowledge is lacking about the extent of the cutaneous area anesthetized by established LFC nerve block techniques, as well as the success rate of anesthetic coverage of various surgical incisions. Nerve block techniques that rely on ultrasonographic identification of the LFC nerve distal to the inguinal ligament can be technically challenging. Furthermore, the branching of the LFC nerve is variable, and it is unknown if proximal LFC nerve branches are anesthetized using the current techniques. The primary aim of this study was to investigate a novel ultrasound-guided LFC nerve block technique based on injection into the fat-filled flat tunnel (FFFT), which is a duplicature of the fascia lata between the sartorius and the tensor fasciae latae muscle, in order to assess the success rate of anesthetizing the proximal LFC nerve branches and covering of the different surgical incisions used for hip surgery.

Methods First, a cadaveric study was conducted in order to identify an FFFT injection technique that would provide adequate injectate spread to the proximal LFC nerve branches. Second, a clinical study was conducted in a group of 20 healthy volunteers over 2 consecutive days. On trial day 1, successful complete anesthesia of the LFC nerve was defined by performing a suprainguinal fascia iliaca block bilaterally in each subject. On trial day 2, a triple-blind randomized controlled trial compared the effect of the novel ultrasound-guided LFC nerve block technique for bupivacaine versus placebo. The primary end point was the success rate of anesthesia of the proximal cutaneous area innervated by the LFC nerve for the FFFT injection with bupivacaine versus placebo.

Results Adequate spread of injectate to the proximal LFC nerve branches in cadavers was obtained by injecting 10 mL with dynamic needle-tip tracking in the FFFT. Application of this technique in the randomized controlled trial provided anesthesia of the lateral thigh with a success rate of 95% (95% confidence interval, 73.9%–99.8%) for the active side and 0% for placebo (P < 0.001). The proximal branches were anesthetized with a success rate of 68% (95% confidence interval, 43.4%–87.4%) on the active side. The proximal extent of the anesthetized cutaneous area was on average 7.9 cm distal to the greater trochanter.

Conclusions This novel LFC nerve block technique is easy and quick and reliably produces anesthesia of the lateral thigh. The greater trochanter is rarely included in the area of anesthesia, which reduces the coverage of each specific surgical incision. The success rate of 68% in anesthetizing the proximal nerve branches must be further evaluated by future research.

Statistics from Altmetric.com

Footnotes

  • The study was supported by the A. P. Møller and Chastine Mc-Kinney Møller Foundation.

    The authors declare no conflict of interest.

    The content of this article is solely the responsibility of the authors.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.