II. Anatomy: Landmarks (from Anterolateral to Posteromedial)
III. Indications
- Diagnostic to differentiate Meralgia Paresthetica from other causes of anterolateral thigh pain
IV. Precautions
- See Regional Anesthesia (Nerve Block)
- Avoid injecting directly into nerves
V. Preparation
- Needle: 27 gauge 1.5 inch
- Skin Preparation (e.g. Hibiclens or Betadine)
-
Anesthetic
- See Regional Anesthesia for Anesthetic options
- Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)
VI. Technique: Ultrasound-Guided (preferred)
- Patient position
- Supine position
-
Ultrasound Probe
- Linear probe positioned transverse over the inguinal ligament
- Lateral probe border parallel with the anterior superior iliac spine (ASIS)
- Linear probe positioned transverse over the inguinal ligament
- Injection
- Needle inserted just lateral to the anterior superior iliac spine (ASIS)
- Needle directed in-plane (beneath the Ultrasound probe) at a 30 degree angle
- Inject at the perineural space
VII. Technique: Landmarks
- Patient position
- Supine position
- Identify landmarks
- Identify anterior superior iliac spine (ASIS)
- Injection
- Insert needle 2 cm medial and 2 cm distal to ASIS
- Angle the needle 30-45 degrees, directed toward the midline
- Advance the needle 1 cm and inject
- Warning: Distal Paresthesias with needle with injection
- Indicates needle is in nerve
- Do not inject here!
- Remove needle and reposition