Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study
Background: Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This no...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | BJA Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609623000059 |
| _version_ | 1827980658394267648 |
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| author | Kris Vermeylen David Van Aken Barbara Versyck Sari Casaer Ronald Bleys Peter Bracke Gerbrand Groen |
| author_facet | Kris Vermeylen David Van Aken Barbara Versyck Sari Casaer Ronald Bleys Peter Bracke Gerbrand Groen |
| author_sort | Kris Vermeylen |
| collection | DOAJ |
| description | Background: Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed. Methods: We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients. Results: The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1). Conclusion: We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology. |
| first_indexed | 2024-04-09T21:56:55Z |
| format | Article |
| id | doaj.art-f1aab937ec024351b6ef2edcca4aa486 |
| institution | Directory Open Access Journal |
| issn | 2772-6096 |
| language | English |
| last_indexed | 2024-04-09T21:56:55Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj.art-f1aab937ec024351b6ef2edcca4aa4862023-03-24T04:23:35ZengElsevierBJA Open2772-60962023-03-015100127Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot studyKris Vermeylen0David Van Aken1Barbara Versyck2Sari Casaer3Ronald Bleys4Peter Bracke5Gerbrand Groen6Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium; Corresponding author.Department of Anaesthesia, Department of Radiology, AZ Klina, Brasschaat, BelgiumDepartment of Anaesthesia, AZ Turnhout, Turnhout, Belgium; Department of Anaesthesia, Catharina Hospital, Eindhoven, the NetherlandsDepartment of Anaesthesia, Gasthuiszusters Antwerpen, Antwerp, BelgiumDepartment of Functional Anatomy, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Radiology, AZ Klina, Brasschaat, BelgiumAnesthesiology Pain Center, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the NetherlandsBackground: Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed. Methods: We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients. Results: The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1). Conclusion: We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology.http://www.sciencedirect.com/science/article/pii/S2772609623000059acute pain managementhip surgerylumbosacral plexuspericapsular hip blockposterior hip innervationregional anaesthesia |
| spellingShingle | Kris Vermeylen David Van Aken Barbara Versyck Sari Casaer Ronald Bleys Peter Bracke Gerbrand Groen Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study BJA Open acute pain management hip surgery lumbosacral plexus pericapsular hip block posterior hip innervation regional anaesthesia |
| title | Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study |
| title_full | Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study |
| title_fullStr | Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study |
| title_full_unstemmed | Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study |
| title_short | Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study |
| title_sort | deep posterior gluteal compartment block for regional anaesthesia of the posterior hip a proof of concept pilot study |
| topic | acute pain management hip surgery lumbosacral plexus pericapsular hip block posterior hip innervation regional anaesthesia |
| url | http://www.sciencedirect.com/science/article/pii/S2772609623000059 |
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