Ultrasound Guided Posterior Femoral Cutaneous Nerve Block

Abstract

ÖzetPosterior femoral kutanöz sinir (PFCN) SummaryThe posterior femoral cutaneous nerve (PFCN) is a branch of the sacral plexus. It needs to be implemented as a complementary block for anesthesia or in the surgeries necessitating tourniquet in the suitable cases. We consider target oriented block concept within the PFCN block in the anesthesia implementations with the emergence of ultrasonic regional anesthesia in the practice and with the better understanding of sonoanatomy.

High-resolution ultrasound of the posterior femoral cutaneous nerve: visualization and initial experience with patients

“…In a recently published report of a single case, the PFCN was localized with HRUS and selected as a target for a preoperative nerve block in a subtotal amputation stump [22]. In a similar effort, another research group evaluated a nerve block of the PFCN under image guidance with high-resolution magnetic resonance imaging at different levels of the posterior aspect of the thigh [18].…”

“…The literature on HRUS of the PFCN is scarce. We are aware of one report of a single case with a preoperative nerve block with ultrasound guidance before a skin graft operation on a posttraumatic leg stump [22]. As there is no basic anatomical ultrasound study on the feasibility of the visualization of the PFCN, or on the subsequent application in clinical cases with pain syndromes of the PFCN, or on diagnostic HRUS-guided nerve block, the aim of this study is to investigate the feasibility of visualizing the PFCN with US, and to validate this technique in a series of cases with a suspected lesion of the PFCN.…”

An Ultrasound-Guided Lateral Approach for Proximal Sciatic Nerve Block

“…For example, if above-the-knee amputation is managed only by peripheral nerve blocks, both SN and PFCN blocks are essential in addition to blockade of the nerves derived from the lumbar plexus. 7,8 According to a previous case series regarding the use of peripheral nerve blocks for lower limb amputation, 2 of 5 patients receiving the anterior approach to SN block felt pain on the posterior aspect of the thigh during above-the-knee amputation because of the lack of PFCN block. 7 Another case series regarding above-the-knee amputation, in which femoral and lateral femoral cutaneous nerve blocks and SN block using the anterior or Labat approach were used, reported that 2 patients receiving the anterior Percentages of patients with complete sensory block of the superficial peroneal, tibial, and PFCNs and motor block of the SN assessed at 10, 20, and 30 minutes after an SN block was performed using ultrasound-guided lateral and anterior approaches.…”

“…In clinical practice, blocking not only the SN but also the PFCN is desirable to ensure complete anesthesia for surgical procedures involving a nociceptive stimulus on the posterior thigh, such as above-the-knee amputation 7 and posterior thigh debridement and skin grafts. 8 However, previously reported ultrasound-guided SN block techniques, which can reliably provide concomitant blockade of the PFCN, including the subgluteal approach, involve extra effort and time because of the need to reposition the patient when surgery is performed in patients lying supine. 5,9 The lateral approach for proximal SN block can be performed in patients lying supine similar to the anterior approach, while local anesthetics are injected at the level of the greater trochanter, which is almost the same as the subgluteal approach.…”

Lower Limb Nerve Supply

“…This would provide anesthesia to the knee, leg and foot (Topçu and Aysel, 2014). This would provide anesthesia to the knee, leg and foot (Topçu and Aysel, 2014).…”