Transverse Versus In-Plane Longitudinal Parasagittal Plane Probe Position in Fascia Iliaca Block

Copyright © 2013 American Society of Regio who received a fascia iliaca block for total hip arthroplasty compared with placebo. As indicated by the authors, a limitation of the study may have been the technical aspect of their approach. The target injection site was determined at the junction of the lateral and middle thirds of the line connecting the anterior-superior iliac spine and the pubic tubercle at the intersection of the iliacus and sartorius muscles using an in-plane, lateral-to-medial approach at the level of the femoral crease. One modification of the fascia iliaca block technique, which we apply in our practice, yields promising results in patients undergoing total hip arthroplasty and has been described in the literature as follows. The probe is placed lateral to the border of the lateral and middle third of the inguinal ligament in a 90-degree long-axis view, with the midpoint of the probe over the inguinal ligament. Figure 1 demonstrates the needle in-plane piercing through the fascia iliaca from a subinguinal ligament approach into the iliacus muscle in a cephalad direction with a local anesthetic deposit. A similar technique, described by Hebbard et al, uses a suprainguinal, ultrasoundguided, in-plane directed needle approach into the iliac fossa with local anaesthetic freelymoving over the iliac muscle and deep to the fascia iliaca. This technique has been shown to be both effective and safe in their clinical experience in more than 150 patients and in their cadaver studies. It would be worthwhile exploring whether the aforementioned modification of the probe position in conducting the fascia iliaca block would have yielded better efficacy with regard to improved numeric rating scores and opioid consumption in the trial conducted by Shariat et al.

版权所有©2013美国区域学会。与安慰剂相比，接受髂筋膜阻滞用于全髋关节置换术的情况。正如作者所指出的，该研究的一个局限性可能在于其方法的技术层面。目标注射部位是在连接髂前上棘和耻骨结节的连线的外侧三分之一与中间三分之一交界处确定的，即在髂肌和缝匠肌相交处，采用在股骨皱褶水平从外侧向内侧的平面内进针方法。我们在实践中应用的髂筋膜阻滞技术的一种改良方法，在接受全髋关节置换术的患者中取得了有希望的结果，并且在文献中描述如下。将探头以90度长轴视图放置在腹股沟韧带外侧和中间三分之一边界的外侧，探头中点位于腹股沟韧带上方。图1展示了从腹股沟韧带下方进针，在平面内穿过髂筋膜，朝着头侧方向进入髂肌并注射局部麻醉药的情况。Hebbard等人描述的一种类似技术，采用在腹股沟韧带上方、超声引导下、平面内进针指向髂窝的方法，局部麻醉药在髂肌上方和髂筋膜深部自由扩散。在他们对150多名患者的临床经验以及尸体研究中，这种技术已被证明是有效且安全的。探讨在Shariat等人进行的试验中，上述在进行髂筋膜阻滞时探头位置的改良是否会在改善数字评分和阿片类药物使用方面产生更好的效果，将是有价值的。