Ilioinguinal Nerve, Iliohypogastric Nerve, Inguinal Canal, TAP
Ilioinguinal Nerve, Iliohypogastric Nerve, Inguinal Canal, TAP
Ilioinguinal Nerve, Iliohypogastric Nerve, Inguinal Canal, TAP
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<strong>Ilioinguinal</strong> & <strong>Iliohypogastric</strong><br />
Cadaver Anatomical Dissection Study<br />
� 10 embalmed cadavers (37)<br />
� 0.1 mL of dye<br />
� 95% success rate<br />
� Validated<br />
� BMI 20.6 kg/m 2<br />
� Location and size<br />
� NBD for II 6 mm*<br />
� Depth of nerves -1.2 cm<br />
� Median diameter – 2 to 3 mm<br />
IO<br />
EO<br />
TA<br />
Lateral<br />
IPDC<br />
Eichenberger. BJA. 2006.<br />
Landmark Based Technique<br />
� Blind technique 21 subjects<br />
� Mean age 72 (range 43-93)<br />
� Medial to the ASIS<br />
�Fascial click<br />
�EO-IO & IO-TA<br />
� Check needle position with ultrasound<br />
�Muscle layers and peritoneum visualized<br />
�<strong>Nerve</strong>s not visualized<br />
� Only 57% positioned between IOM and TAM<br />
�43% found deep to TAM<br />
IPDC<br />
Genitofemoral <strong>Nerve</strong><br />
Anatomy - Genital branch<br />
� Relation to spermatic cord<br />
�Ventral, dorsal, inferior location<br />
�Part of cremaster muscle<br />
� 116 dissections of GFN in IC<br />
�Only 3% outside of SC<br />
� 27 adult cadavers<br />
� 13% of cases GB and II unite<br />
�GB nerve varies considerably<br />
�3 pathways<br />
ASIS<br />
Peritoneum<br />
Randhawa. Can J Anesth. 2010.<br />
Schuenke. Thieme Atlas of Anatomy. 2010.<br />
Liu. Eur J Surg. 2002.<br />
Akita. Anat Med Rad Surg Tech. 1998.<br />
ASIS<br />
Be Careful of the Vessel<br />
ASIS<br />
IPDC IPDC<br />
Genitofemoral <strong>Nerve</strong><br />
Anatomy<br />
� L1 & L2<br />
� Femoral branch<br />
�Sensory � thigh<br />
� Genital branch (mixed)<br />
�Women - round ligament<br />
�Labia majora<br />
�Mons pubis<br />
�Men - spermatic cord<br />
�Cremasteric muscles & scrotum Rab. Plast Reconstr Surg. 2001.<br />
Genitofemoral <strong>Nerve</strong><br />
Traditional Technique-Genital Branch<br />
� Pubic tubercle & inguinal ligament<br />
� Point lateral to pubic tubercle<br />
� Below inguinal ligament<br />
� Field block - � volume LA<br />
IPDC<br />
� Concerns<br />
�Peritoneal cavity & abdominal viscera<br />
�Femoral artery<br />
PS<br />
PT PT<br />
�SC structures (testicular artery & vas deferens)<br />
Schuenke. Thieme Atlas of Anatomy. 2010.<br />
5/18/2012<br />
2
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