Download Blocks of the ilioinguinal, iliohypogastric

Ilioinguinal, Iliohypogastric and
LCNT & Genitofemoral
Dr Barry Nicholls. Taunton UK
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Ilioinguinal &
Iliohypogastric nerves
Anatomy

The anterior primary rami of L1 divides into the iliohypogastric and ilioinguinal
nerves.

The nerves enter the abdomen posterior to the medial arcuate ligament(what's this)
?from the diaphragm

They pass anterolateral to quadratus lumborum and pierce the Transversus
Abdominis muscle close to the anterior superior iliac spine (ASIS).

The nerves pass close to the ASIS in the neurovascular plane (between
Transversus Abdominis and internal oblique), before piercing the external oblique
to reach the superficial tissues

They supply the muscles and skin of the inguinal and pubic regions.

The anterior primary ramus of L1 may divide as far anterior as the ASIS, with only
one nerve crossing the posterior abdominal wall

The subcostal nerve arises from T12, courses in the same plane as above, and
divides into a branch which supplies the upper border of the postero-lateral thigh
and buttock. ...,
Indications
 n = 11265
 Chronic Pain: 12%
Br J Anaesth 2006 Aug;97(2):238-43
In-plane technique
Out of plane technique
Lateral Cutaneous
Nerve of the Thigh
(LCNT)
Anatomy
 The lateral cutaneous nerve of the thigh is a pure sensory nerve,
 It arises from the dorsal rami of L2 and L3 (lumbar plexus).
 It emerges from the lateral border of psoas major, below the iliac
crest, and crosses the iliacus muscle anteriorly (deep to its fascia)
obliquely towards the anterior superior iliac spine (ASIS).
 It passes under the inguinal ligament at a variable distance from
the ASIS (typically 1cm - Range: 3mm to 7cm), and crosses over
the sartorius muscle in the thigh. (Range: 2 to 11cm distal to the
ASIS)
 It divides into anterior and posterior branches to supply the skin of
the lateral thigh.
Anatomy
Probe position
Ultrasound appearance
Technique
Needle Path
Genitofemoral nerve
 Indications
 Genitofemoral neuralgia
Anatomy
 The genitofemoral nerve (GFN) arises from the roots of L1 and L2
(lumbar plexus) within the psoas muscle.
 It penetrates the psoas muscle at L3/4 to lie on its anterior surface.
 It divides into a genital and femoral branch at a variable distance above
the inguinal ligament. (Approximately 1-1.5cm)
 Femoral branch: Follows the external iliac artery and passes under
the inguinal ligament superficial to the femoral sheath. (Sensory: skin
- upper medial aspect of the thigh).
 Genital branch: The nerve lies lateral to the inferior epigastric artery at
1 - 1.5 cm above the inguinal ligament. It passes through the deep
(internal) inguinal ring and inguinal canal and lies within the spermatic
cord.. (Sensory/motor - anterolateral aspect of the scrotum and
cremaster muscle).
Genitofemoral nerve
Probe position
Femoral artery / inferior
Epigastric artery
Approach
 Thanks to Dr
his slides .
Jens Keesler for permission to use