• Paediatric anaesthesia · May 2013

    Revisiting the anatomy of the ilio-inguinal/iliohypogastric nerve block.

    • Albert-Neels van Schoor, Marius C Bosman, and Adrian T Bosenberg.
    • Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. albert.vanschoor@up.ac.za
    • Paediatr Anaesth. 2013 May 1;23(5):390-4.

    BackgroundThe ilio-inguinal/iliohypogastric nerve block (INB) is one of the most common peripheral nerve block techniques in pediatric anesthesia, which is largely due to the introduction of ultrasound (US) guidance. Despite the benefits of US guidance, the absence of an US machine should not deter the provider from performing INB, considering that many institutions, especially in developing countries, cannot afford to provide ultrasound machines in their anesthesiology departments. The aim of this study was to revisit the anatomical position of the ilio-inguinal and iliohypogastric nerves in relation to the anterior superior iliac spine (ASIS), in a large sample of neonatal cadavers, and compare the results with a similar group in a previously published US-guided study.MethodsWith Ethics Committee approval, the ilio-inguinal and iliohypogastric nerves were carefully dissected in 54 neonatal cadavers.ResultsIn the total sample, the ilio-inguinal nerve was found to be 2.2 ± 1.2 mm from the ASIS, on a line connecting the ASIS to the umbilicus. The iliohypogastric nerve was on average 3.8 ± 1.3 mm from the ASIS. For the entire sample, the optimal needle insertion site was 3.00 mm from the ASIS. Although there is a strong correlation between the needle insertion point and the weight of the neonate, this will only 'fit' for 60% of the population.ConclusionThe linear regression formula; needle insertion distance (mm) = 0.6 × weight + 1.8 can be used as a guideline for the position of the ilio-inguinal and iliohypogastric nerves.© 2012 Blackwell Publishing Ltd.

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