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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Ultrasound-guided block of the superior gluteal nerve (SGNB) for pelvic girdle analgesia is sparsely documented in medical literature, motivating us to conduct an anatomical study aiming to describe a straightforward approach to this nerve, guided by clear anatomical references.
Methods An anatomical study was conducted on fifteen cadaveric models (thirty pelvic girdles), utilizing ultrasound-guided SGNB with a low-frequency convex ultrasound probe. The probe was positioned over the iliac bone in a superolateral oblique plane, scanning from superolateral to inferomedial. Structures identified included: continuous iliac bone (figure 1-A), beginning of the greater sciatic foramen (figure 1-B), and piriformis muscle (figure 1-C). Subsequently, the probe was retracted towards the continuous iliac bone (figure 1-A) in the fascial plane between the gluteus medius and minimus muscles, identifying the superior gluteal artery, and injecting 5 ml of a solution mixture (methylene blue + iodine). Three-dimensional reconstruction (3D) using computed tomography (CT) and subsequent sectional anatomy were performed on five cadaveric models. Anatomical dissection by planes of each hemipelvis was carried out on ten cadaveric models.
Results In the 3D reconstruction via CT, contrast dispersion over the supero-lateral gluteal region was visualized (figure 2). In anatomical dissection and sectional anatomy, methylene blue distribution was observed in the muscular fascial plane between the gluteus medius and minimus, affecting the superior gluteal vasculonervous bundle (figure 3).
Sequence of scanning for SGNB and its correlation between sectional anatomy and ultrasound. It shows: Iliac bone (1); Superior gluteal nerve (2); Gluteus minor muscle (3); Piriformis muscle (4); Gluteus medius muscle (5); Gluteus maximus muscle (6); Sciatic foramen and sciatic nerve (7)
Three-dimensional reconstruction via computed tomography showing contrast dispersion over the superolateral gluteal region
Results of anatomical dissection by planes and their correlation with an anatomical illustration of the gluteal region (figure 3A); and the results of sectional anatomy (figure 3B). Consistent staining with methylene blue of the superior gluteal vasculonervous bundle is observed. Identified structures include: Iliac bone (1); Superior gluteal nerve (2); Gluteus minor muscle (3); Piriformis muscle (4); Gluteus medius muscle (5); Gluteus maximus muscle (6); Sciatic foramen and sciatic nerve (7)
Conclusions Intergluteal SGNB consistently affects the superior gluteal vasculonervous bundle, proving to be a straightforward technique guided by clear anatomical references.