The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest

Kosiyatrakul, Arkaphat; Nuansalee, Nattapol; Luenam, Suriya; Koonchornboon, Tunyarut; Prachaporn, Sunya

doi:10.1007/s12306-010-0054-y

Cited by 34 publications

(24 citation statements)

References 26 publications

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“…1). These results are consistent with previous observations, wherein a lateral course of the LFCN was found in 4% to 19% of cases 19,20,25,47,48 . In particular, a lateral course of an LFCN branch must be considered in cases when a proximal extension of the anterior approach to the hip joint is needed.…”

Section: Course O F T H E Lat E R a L Femoral Cutaneous N E Rv E W I supporting

confidence: 93%

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

Rudin

Manestar

Ullrich

et al. 2016

The Journal of Bone and Joint Surgery

110

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BACKGROUND: Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint. METHODS: Twenty-eight cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected. The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh. Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded. RESULTS: We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness. In 50% of the specimens, the LFCN divided into 2 branches superior to the inguinal ligament. Sixty-two percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS. The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue. CONCLUSIONS: Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue. Background: Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the

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Section: Course O F T H E Lat E R a L Femoral Cutaneous N E Rv E W I supporting

confidence: 93%

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

Rudin

Manestar

Ullrich

et al. 2016

The Journal of Bone and Joint Surgery

110

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“…Mischkowski et al (2006) found the nerve superolateral to the ASIS in 2.9% cases, Aszmann et al (1997) andde Ridder et al (1999) in 4% of specimens, and Murata et al (2000) in 13% of cases. Kosiyatrakul et al (2010) reported that 58.3% of the LFCN passed medial to the ASIS, 22.9% passed at the ASIS, and 18.8% passed lateral to it.…”

Section: Discussionmentioning

confidence: 99%

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance

et al. 2010

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The lateral femoral cutaneous nerve (LFCN), a branch from the lumbar plexus, may come to the clinician's or surgeon's attention. We studied this nerve to determine its location and its relationship with neighboring structures around the anterior superior iliac spine (ASIS) and the inguinal ligament (IL). Additionally, cross-sectional microanatomy of the LFCN at the IL was studied. The LFCN was dissected in 47 lower limbs from formalin-fixed cadavers. The distances from the ASIS to the point where the LFCN crossed the IL and the lateral border of the sartorius were measured. The distance between the ASIS and the point it pierced the deep fascia was also measured. Twelve nerve specimens at the IL were collected for histological sectioning and were stained with hematoxylin and eosin. On examination of the cross-sectional area, the nonfascicular area was wider than the fascicular area because of an increased amount of thick collagen fibers. This study may be of help to clinicians managing meralgia paresthetica and may also assist in defining a safe area for surgical intervention on the anterolateral aspect of the thigh.

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“…The study included the following 12 (a-m) secondary outcomes: (a) distance from the proximal margin of the anesthetized area to the greater trochanter after the LFC nerve block; (b) distance from the proximal margin of the anesthetized area to the greater trochanter after the SI-FIC block; (c) distance from the distal margin of the anesthetized area to the tibiofemoral joint line after the LFC nerve block; (d) distance from the distal margin of the anesthetized area to the tibiofemoral joint line after the SI-FIC block (the distal extent of the SI-FIC block was not measured beyond the tibiofemoral joint line; in case of anesthesia distal to the joint line, the distance was registered as 0 cm); (e) inclusion of each marked surgical incision line in the anesthetized area after the LFC nerve block (total, partial, or absent inclusion); ( f ) success rate of total inclusion of the distal locking incision of the long intramedullary (IM) nail; (g) anteromedial and posterolateral extent of the anesthetized area after the LFC nerve block; (h) frequency of motor block of the femoral nerve after the LFC nerve block (motor block was defined as at least 25% reduction in MVIC compared with baseline measurements); (i) frequency of motor block of the femoral nerve after the SI-FIC block; ( j) duration of anesthesia after the LFC nerve block; (k) quality of ultrasonographic visualization of the LFC nerve inside the FFFT (good, reduced, poor); (l) LFC nerve block performance time; (m) discomfort during LFC nerve block performance (numeric rating scale [NRS] 0-10 from no discomfort [0] to worst imaginable discomfort [10]). …”

Section: Secondary End Pointsmentioning

confidence: 99%

The Lateral Femoral Cutaneous Nerve

Nielsen

Moriggl

Barckman

et al. 2018

Regional Anesthesia and Pain Medicine

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Background and ObjectivesNerve blockade of the lateral femoral cutaneous (LFC) nerve provides some analgesia after hip surgery. However, knowledge is lacking about the extent of the cutaneous area anesthetized by established LFC nerve block techniques, as well as the success rate of anesthetic coverage of various surgical incisions. Nerve block techniques that rely on ultrasonographic identification of the LFC nerve distal to the inguinal ligament can be technically challenging. Furthermore, the branching of the LFC nerve is variable, and it is unknown if proximal LFC nerve branches are anesthetized using the current techniques. The primary aim of this study was to investigate a novel ultrasound-guided LFC nerve block technique based on injection into the fat-filled flat tunnel (FFFT), which is a duplicature of the fascia lata between the sartorius and the tensor fasciae latae muscle, in order to assess the success rate of anesthetizing the proximal LFC nerve branches and covering of the different surgical incisions used for hip surgery.MethodsFirst, a cadaveric study was conducted in order to identify an FFFT injection technique that would provide adequate injectate spread to the proximal LFC nerve branches. Second, a clinical study was conducted in a group of 20 healthy volunteers over 2 consecutive days. On trial day 1, successful complete anesthesia of the LFC nerve was defined by performing a suprainguinal fascia iliaca block bilaterally in each subject. On trial day 2, a triple-blind randomized controlled trial compared the effect of the novel ultrasound-guided LFC nerve block technique for bupivacaine versus placebo. The primary end point was the success rate of anesthesia of the proximal cutaneous area innervated by the LFC nerve for the FFFT injection with bupivacaine versus placebo.ResultsAdequate spread of injectate to the proximal LFC nerve branches in cadavers was obtained by injecting 10 mL with dynamic needle-tip tracking in the FFFT. Application of this technique in the randomized controlled trial provided anesthesia of the lateral thigh with a success rate of 95% (95% confidence interval, 73.9%–99.8%) for the active side and 0% for placebo (P < 0.001). The proximal branches were anesthetized with a success rate of 68% (95% confidence interval, 43.4%–87.4%) on the active side. The proximal extent of the anesthetized cutaneous area was on average 7.9 cm distal to the greater trochanter.ConclusionsThis novel LFC nerve block technique is easy and quick and reliably produces anesthesia of the lateral thigh. The greater trochanter is rarely included in the area of anesthesia, which reduces the coverage of each specific surgical incision. The success rate of 68% in anesthetizing the proximal nerve branches must be further evaluated by future research.

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The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest

Cited by 34 publications

References 26 publications

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance

The Lateral Femoral Cutaneous Nerve

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