Spread of injectate around hip articular sensory branches of the femoral nerve in cadavers

• Published in: Acta anaesthesiologica Scandinavica 2018-08, Vol.62 (7), p.1001-1006
• Main Authors: Nielsen, N. D., Greher, M., Moriggl, B., Hoermann, R., Nielsen, T. D., Børglum, J., Bendtsen, T. F.
• Format: Article
• Language: English
• Subjects: Anesthesia; Biomedical materials; cadaver study; Cadavers; Confidence intervals; Dissection; Dyes; femoral nerve; Femur; Hip; hip arthroplasty; hip joint; Injection; Joint surgery; Muscles; nerve blockade; Nerves; Surgical implants; Total hip arthroplasty; Ultrasonic imaging; Ultrasound
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.13122

Background Anatomical knowledge dictates that regional anaesthesia after total hip arthroplasty requires blockade of the hip articular branches of the femoral and obturator nerves. A direct femoral nerve block increases the risk of fall and impedes mobilisation. We propose a selective nerve block of the hip articular branches of the femoral nerve by an ultrasound‐guided injection in the plane between the iliopsoas muscle and the iliofemoral ligament (the iliopsoas plane). The aim of this study was to assess whether dye injected in the iliopsoas plane spreads to all hip articular branches of the femoral nerve. Methods Fifteen cadaver sides were injected with 5 mL dye in the iliopsoas plane guided by ultrasound. Dissection was performed to verify the spread of injectate around the hip articular branches of the femoral nerve. Results In 10 dissections (67% [95% confidence interval: 38‐88%]), the injectate was contained in the iliopsoas plane staining all hip articular branches of the femoral nerve without spread to motor branches. In four dissections (27% [8‐55%]), the injection was unintentionally made within the iliopectineal bursa resulting in secondary spread. In one dissection (7% [0.2‐32%]) adhesions partially obstructed the spread of dye. Conclusion An injection of 5 mL in the iliopsoas plane spreads around all hip articular branches of the femoral nerve in 10 of 15 cadaver sides. If these findings translate to living humans, injection of local anaesthetic into the iliopsoas plane could generate a selective sensory nerve block of the articular branches of the femoral nerve without motor blockade.