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Superior Cluneal Nerve Injection: Difference between revisions
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==Technique== | ==Technique== | ||
[[File:SCN block.PNG|thumb|right|SCN block. The needle is inserted through the thoracolumbar fascia (yellow line), close to the lateral edge of | [[File:SCN block.PNG|thumb|right|SCN block. The needle is inserted through the thoracolumbar fascia (yellow line), close to the lateral edge of iliocostalis where the posterior layer fuses with the anterior fascial layer (blue line). The red line is the lumbar intermuscular aponeurosis.</br><small>© American Society of Regional Anesthesia & Pain Medicine 2019</small>]] | ||
[[File:SCN block2.PNG|thumb|right|The needle is inserted in plane from a lateral to medial direction through the thoracolumbar fascia (yellow line). Intermuscular aponeurosis is shown (red arrow).</br><small>© American Society of Regional Anesthesia & Pain Medicine 2019</small>]] | [[File:SCN block2.PNG|thumb|right|The needle is inserted in plane from a lateral to medial direction through the thoracolumbar fascia (yellow line). Intermuscular aponeurosis is shown (red arrow).</br><small>© American Society of Regional Anesthesia & Pain Medicine 2019</small>]] | ||
Injection can be done by landmark guided palpation based on the maximal area of tenderness, and/or by ultrasound guidance. | Injection can be done by landmark guided palpation based on the maximal area of tenderness, and/or by ultrasound guidance. | ||
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===Ultrasound Guided=== | ===Ultrasound Guided=== | ||
An ultrasound guided technique has been developed, in a cadaveric and live human randomised study.<ref>{{#pmid:31061111}}</ref> | An ultrasound guided technique has been developed, in a cadaveric and live human randomised study.<ref>{{#pmid:31061111}}</ref> | ||
*Position:Laterla decubitus | |||
*Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves. | |||
*Probe:High frequency linear transducer. | |||
*Identify the lateral border of the erector spinae muscle at the level of the superior margin of the iliac crest, which fuses laterally with the transverse abdominis aponeurosis. | |||
*Trace the erector spinae caudally to the level of the iliac crest | |||
*Keep the transducer cranial to the level of where the lumbar intermuscular aponeurosis fuses with the posterior layer of the thoracolumbar fascia. | |||
*Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae. | |||
*The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially. | |||
===Fluoroscopy Guided=== | ===Fluoroscopy Guided=== | ||
Revision as of 18:40, 7 September 2020
This article is a stub.
| |
| Superior Cluneal Nerve Injection | |
|---|---|
| Indication | Cluneal nerve pain |
| Syringe | 10mL |
| Needle | 80mm nerve block needle |
| Steroid | optional |
| Local | doctor choice |
| Volume | ?10-15mL |
Anatomy
Indications
Contraindications
Pre-procedural Evaluation
Equipment
Technique
SCN block. The needle is inserted through the thoracolumbar fascia (yellow line), close to the lateral edge of iliocostalis where the posterior layer fuses with the anterior fascial layer (blue line). The red line is the lumbar intermuscular aponeurosis.
© American Society of Regional Anesthesia & Pain Medicine 2019
© American Society of Regional Anesthesia & Pain Medicine 2019
Injection can be done by landmark guided palpation based on the maximal area of tenderness, and/or by ultrasound guidance.
Ultrasound Guided
An ultrasound guided technique has been developed, in a cadaveric and live human randomised study.[1]
- Position:Laterla decubitus
- Target: Subfascial layer between the thoracolumbar fascia and erector spinae to ensure injectate spread to all superior cluneal nerves.
- Probe:High frequency linear transducer.
- Identify the lateral border of the erector spinae muscle at the level of the superior margin of the iliac crest, which fuses laterally with the transverse abdominis aponeurosis.
- Trace the erector spinae caudally to the level of the iliac crest
- Keep the transducer cranial to the level of where the lumbar intermuscular aponeurosis fuses with the posterior layer of the thoracolumbar fascia.
- Insert needle lateral to medial, pierce the thoracolumbar fascia just medial to the point of fusion with the anterior layer at the lateral margin of the erector spinae.
- The erector spinae muscle and posterior layer of the thoracolumbar fascia should separate during injection, and as this happens move the needle medially.
