Ultrasound-guided block procedures
anterior inferior iliac spine, fascia iliaca block, pain, femoral cutaneous nerve, transverse abdominus muscle
LOCAL INFILTRATION, INFILTRATED
Peripheral vein access was established after the patients entered operating room, and non-invasive blood pressure (NIBP), heart rate (HR), and peripheral capillary oxygen saturation (SpOPENG + LFCN block: The low-frequency curvilinear probe (3–5 MHz) of ultrasound (GE Logiq e, GE Healthcare, USA) was placed in a transverse plane over the anterior inferior iliac spine (AIIS) and aligned with the pubic ramus by rotating the probe counterclockwise to obtain a hyperechoic bright line, which is the iliopubic eminence (IPE). In this view, the iliopsoas muscle and psoas tendon, the femoral artery, and pectineus muscle were observed. Using the in-plane injection technique, a 22G, 80 mm insulated block needle was inserted in a lateral-to-medial direction, and the tip was placed between the psoas tendon anteriorly and the pubic ramus posteriorly. After no blood was drawn back, the LA (20 ml, 0.33% ropivacaine) was injected to get an image of the psoas tendon uplifted (Fig. Images of ultrasound-guided pericapsular nerve group (PENG) block. The figure on the left shows the ultrasonic anatomy of PENG block; the needle tip was positioned between the psoas tendon and the pubic ramus using an in-plane approach. The figure on the right shows the local anesthetic spread following injection. Asterisk, target for local anesthetic injection; arrow, needle pathway; area circled by dashed line, local anesthetic spread; AIIS, anterior inferior iliac spine; IPE, iliopubic eminence; PT, psoas tendon; FA, femoral arteryImages of ultrasound-guided lateral femoral cutaneous nerve (LFCN) block. The needle tip was positioned in the tunnel formed by the fascia between the sartorius and the tensor fascia lata. Dashed arrow, needle pathway; large arrows, LFCN; TFL, tensor fascia lata; RF rectus femoris; Sa, sartoriusS-FICB: A high-frequency linear probe (6–12 MHz) of ultrasound (GE Logiq e, GE Healthcare, USA) was used. The probe was placed adjacent to the inguinal ligament with its long axis parallel to the ligament. After the femoral artery and the femoral nerve was observed, the probe was moved laterally to identify the sartorius muscle and placed it at the center of the screen. Then the probe was moved cephalically to the anterior superior iliac spine (ASIS) until the image of the sartorius muscle disappeared, and the medial side of ASIS was identified as the iliacus muscle. Next, by rotating the medial end of the ultrasound probe toward the umbilicus, the ASIS, iliac bone, and abdominal muscles were observed on the screen. Using the in-plane technique, a 22G, 80 mm insulated block needle was inserted in a lateral-to-medial direction. When the needle tip penetrated below the fascia iliacus, the LA (30 ml, 0.33% ropivacaine) was injected following negative aspiration to obtain an image showing the LA spread between the iliacus muscle and the fascia iliacus (Fig. Images of ultrasound-guided supra-inguinal fascia iliaca block (S-FICB). The needle tip was located under the fascia iliacus between the transversal abdominus muscle and iliac muscle. Dashed arrow, needle pathway. IO internal oblique muscle, TA transverse abdominus muscle, IM iliacus muscle, ASIS anterior superior iliac spinePain scores with a straight leg raise of the affected limb to 15 degrees were assessed by the same blinded investigator before and 30 min after block performance. Subsequently, this investigator assessed the block of LFCN by testing for loss of pain sensation on the lateral thigh. Successful block performance was defined as a reduction in pain score compared to before the intervention and loss of pain sensation on the lateral thigh. Case of unsuccessful block performance were not included in the statistical analysis. If the nerve block was unsuccessful, the investigator who previously assessed the effects of the block would ask the surgeon to perform local infiltration analgesia (LIA) at the end of the surgical procedure, which involved injecting 20 ml 0.33% ropivacaine around the joint capsule and 10 ml 0.33% ropivacaine infiltrated around the wound.