Comparing the Distances of Different Intramuscular Gluteal Injection Sites to the Sciatic Nerve

Abstract

Introduction: Sciatic nerve injury is a well-known complication of intra-muscular gluteal muscle injections. Affected individuals usually present with foot drop and this results in varying degrees of motor disability. There are different sites such as ventrogluteal, dorsogluteal that can be used for gluteal injections. In last years, the ventrogluteal site is accepted as a more safe and suitable injection site than dorsogluteal site. This study was carried out to compare the distance to the siatic nerve under the piriformis muscle of these different gluteal injection sites. The study also aimed to evaluate the muscle thicknesses at these injection sites. Materials and Methods:Twenty five participants with BMI<22 were recruited from outpatient clinic that were prescribed intramuscular treatment. Firstly, by an experienced nurse the dorsogluteal and ventrogluteal injection points have been marked. By using a linear array probe (7-12 MHz Logiq P5a) the distances of both the dorsogluteal and ventrogluteal sites to the siatic nerve just under the piriformis muscle have been measured. Later on the muscle thickness at these sites were measured. Result:The mean distances between the dorsogluteal and ventrogluteal injection points to the siatic nerve under the piriformis muscle are consecutively 9±2.3cm and 18±3.5 cm. No statistical difference has been found between the muscle thickness of the ventrogluteal and dorsogluteal injections sites (p<0.01). Conclusion:According to the distance to sciatic nerve, the ventrogluteal injection site seems a more advisable and safe injection point.has been measured and recorded. The muscle thickness (gluteus maximus) at this injection side also measured ultra sonographically.At the second step of our study, a more safe and advisable injection side has been determined at the ventrogluteal region (gluteus medius and minimus muscle) under the iliac crest. The distances of this second injection point to the siatic nerve under the piriformis muscle have also been measured. Also for standardization the distance of this advised point to the spinal iliaca anterior superior have also been measured. The muscle thicknesses at this point have also been measured ultrasonographically. ResultsThe results were evaluated by SPSS statistical software programme. Mann-Whitney U test were used to compare the differences. Eleven of the patients were woman, and 14 of them were men. The mean age of the participant was 37±13 and the mean BMI were 18± 2.5 kg. The mean distance between the dorsogluteal injection points to the siatic nerve under the piriformis muscle is 9±2.3 cm. The mean muscle thickness at this point was 22±5.6 cm. The mean distance of the second more advisable and safe injection point at ventrogluteal side to the siatic nerve was 18±3.5 cm. The mean muscle thickness at this point is 24±6.5 mm. The distance of this point to the spina iliaca anterior superior obliquely is 9.5±2.2 cm. There was a significant difference between the distance to the sciatic nerve of dorsogluteal and ventrog...

Creating a change in the use of ventrogluteal site for intramuscular injection

“…In the literature, there is information on the large structure of the muscle layer in the VG site. 18 , 30 On the other hand, Yalcin et al 21 and Coskun et al 24 found that there was no statistically significant difference between the muscle thickness of VG and DG sites. Furthermore, Kaya et al 10 and Elgellaie et al 11 reported that the muscle tissue in the VG site was thicker.…”

“…In literature, it is reported that the majority of nurses preferred using the DG site, which was also supported by other researchers. 2 , 21 – 25 It is stated that nurses’ reluctance to use the VG site is caused by lack of confidence about the implementation of the procedure, 26 lack of knowledge on safe gluteal IMI sites and its logic 27 and traditional approaches. 2 , 24 Prior to the training, it was seen that most of the nurses (64%) identified the DG site as the safest site for injection.…”

“…For the past 20 years, the VG site has been considered to be a safer and more suitable injection site than the DG site. 21 …”

Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta‐analysis

“…Yalcin is the only author that calculated, in patients with a BMI < 22, the average distance of the two analysed injection sites to the sciatic nerve: 18 ± 3.5 for VS and 9 ± 2.3 cm for DS (Yalcin et al, 2015). Coskun measured the distance to superior gluteal artery and superior gluteal nerve, but in a cadaveric study, also obtaining a smaller distance towards neurovascular structures in DS (Coskun et al, 2016).…”

“…In this context, the Swiss anatomist (Von Hochstetter, 1954) proposes to avoid injuries to the sciatic nerve and perineuronal area by using the ventrogluteal injection site. Subsequent medical literature has provide evidence of the safety and efficacy of this site, highlighting its distance from the sciatic nerve (Yalcin et al, 2015), relatively low number of veins present (except some branches of superior gluteal artery or vein; Nakajima et al, 2020) and the reduced thickness of the subcutaneous tissue in comparison with the dorsogluteal site (Arslan & Özden, 2018; Elgellaie et al, 2018; Larkin et al, 2018; Nisbet, 2006). However, some studies present ventrogluteal site as an area that is not exempt from risks (Müller‐Vahl, 1985; Obach et al, 1983; Wu et al, 2020).…”