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Original article
Randomized trial of ultrasound-guided superior cluneal nerve block
  1. Thomas Dahl Nielsen1,
  2. Bernhard Moriggl2,
  3. Jeppe Barckman3,
  4. Jan Mick Jensen1,
  5. Jens Aage Kolsen-Petersen1,
  6. Kjeld Søballe3,4,
  7. Jens Borglum5 and
  8. Thomas Fichtner Bendtsen1,4
  1. 1Department of Anesthesiology, Aarhus Universitetshospital, Aarhus, Denmark
  2. 2Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
  3. 3Orthopedic Surgery, Aarhus Universitetshospital, Aarhus, Denmark
  4. 4Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  5. 5Anesthesiology, Zealand University Hospital, Roskilde and Copenhagen University, Copenhagen, Denmark
  1. Correspondence to Dr Thomas Fichtner Bendtsen, Department of Clinical Medicine, Aarhus University, Aarhus 8000, Denmark; tfb{at}dadlnet.dk

Abstract

Background and objectives The superior cluneal nerves originate from the dorsal rami of primarily the upper lumbar spinal nerves. The nerves cross the iliac spine to innervate the skin and subcutaneous tissue over the gluteal region. The nerves extend as far as the greater trochanter and the area of innervation may overlap anterolaterally with the iliohypogastric and the lateral femoral cutaneous (LFC) nerves. A selective ultrasound-guided nerve block technique of the superior cluneal nerves does not exist. A reliable nerve block technique may have application in the management of postoperative pain after hip surgery as well as other clinical conditions, for example, chronic lower back pain. In the present study, the primary aim was to describe a novel ultrasound-guided superior cluneal nerve block technique and to map the area of cutaneous anesthesia and its coverage of the hip surgery incisions.

Methods The study was carried out as two separate investigations. First, dissection of 12 cadaver sides was conducted in order to test a novel superior cluneal nerve block technique. Second, this nerve block technique was applied in a randomized trial of 20 healthy volunteers. Initially, the LFC, the subcostal and the iliohypogastric nerves were blocked bilaterally. A transversalis fascia plane (TFP) block technique was used to block the iliohypogastric nerve. Subsequently, randomized, blinded superior cluneal nerve blocks were conducted with active block on one side and placebo block contralaterally.

Results Successful anesthesia after the superior cluneal nerve block was achieved in 18 of 20 active sides (90%). The area of anesthesia after all successful superior cluneal nerve blocks was adjacent and posterior to the area anesthetized by the combined TFP and subcostal nerve blocks. The addition of the superior cluneal nerve block significantly increased the anesthetic coverage of the various types of hip surgery incisions.

Conclusion The novel ultrasound-guided nerve block technique reliably anesthetizes the superior cluneal nerves. It anesthetizes the skin posterior to the area innervated by the iliohypogastric and subcostal nerves. It improves the anesthetic coverage of incisions used for hip surgery. Among potential indications, this new nerve block may improve postoperative analgesia after hip surgery and may be useful as a diagnostic block for various chronic pain conditions. Clinical trials are mandated.

Trial registration number EudraCT, 2016-004541-82.

  • postoperative pain
  • lower extremity
  • ultrasound in pain medicine
  • anatomy

https://doi.org/10.1136/rapm-2018-100174

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    Footnotes

    • Contributors TDN contributed to the conception and design of the study protocol, recruited all study subjects, conducted the trial, acquired, analyzed and interpreted the data, and authored the initial manuscript. BM contributed to the design of the work, and the acquisition and interpretation of data. JB, JMJ, JAKP, KS and JB contributed to the interpretation of data. TFB contributed to the conception and design of the study protocol, conduct of the trial, and the acquisition, analysis and interpretation of data. All authors read and revised the manuscript critically, approved the final version and agreed to be accountable for all aspects of the work.

    • Funding The study was supported by the AP Møller and Chastine Mc-Kinney Møller Foundation.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The trial was approved by the Danish Health and Medicines Authority, the Central Denmark Region Committee on Biomedical Research Ethics, and the Danish Data Protection Agency.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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