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BJA Advance Access originally published online on May 12, 2006
British Journal of Anaesthesia 2006 97(2):238-243; doi:10.1093/bja/ael103
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection

U. Eichenberger1,*, M. Greher1, L. Kirchmair2, M. Curatolo4 and B. Moriggl3

1 Department of Anaesthesia and General Intensive Care (B), Medical University of Vienna A-1090 Vienna, Austria.
2 Department of Anaesthesia and Intensive Care, Histology and Embryology, Innsbruck Medical University A-6020 Innsbruck , Austria
3 Department of Anatomy, Histology and Embryology, Innsbruck Medical University A-6020 Innsbruck , Austria
4 Department of Anaesthesiology, University Hospital of Berne CH-3010 Bern, Switzerland

*Corresponding author: Department of Anaesthesiology, University Hospital of Berne, Inselspital, CH-3010 Bern, Switzerland. E-mail: urs.eichenberger{at}insel.ch

Background. Ilioinguinal and iliohypogastric nerve blocks may be used in the diagnosis of chronic groin pain or for analgesia for hernia repair. This study describes a new ultrasound-guided approach to these nerves and determines its accuracy using anatomical dissection control.

Methods. After having tested the new method in a pilot cadaver, 10 additional embalmed cadavers were used to perform 37 ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve. After injection of 0.1 ml of dye the cadavers were dissected to evaluate needle position and colouring of the nerves.

Results. Thirty-three of the thirty-seven needle tips were located at the exact target point, in or directly at the ilioinguinal or iliohypogastric nerve. In all these cases the targeted nerve was coloured entirely. In two of the remaining four cases parts of the nerves were coloured. This corresponds to a simulated block success rate of 95%. In contrast to the standard ‘blind’ techniques of inguinal nerve blocks we visualized and targeted the nerves 5 cm cranial and posterior to the anterior superior iliac spine. The median diameters of the nerves measured by ultrasound were: ilioinguinal 3.0x1.6 mm, and iliohypogastric 2.9x1.6 mm. The median distance of the ilioinguinal nerve to the iliac bone was 6.0 mm and the distance between the two nerves was 10.4 mm.

Conclusions. The anatomical dissections confirmed that our new ultrasound-guided approach to the ilioinguinal and iliohypogastric nerve is accurate. Ultrasound could become an attractive alternative to the ‘blind’ standard techniques of ilioinguinal and iliohypogastric nerve block in pain medicine and anaesthetic practice.


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