Abstract
Amaç: Anterior iliak krest (AİK), rekonstrüktif cerrahilerde sıklıkla greft donör sahası olarak tercih edilmektedir. Ancak bu bölgeye yönelik girişimler, morbiditeyi artıran ciddi postoperatif ağrılarla ilişkilidir. Donör bölgesine düşük hacimde lokal anesik ile analjezi sağlamak amacıyla “anterior iliak blok (AİB)” adı verilen yeni bir teknik tanımlanmıştır. AİB etkili bir analjezi sağlasa da etki mekanizması açık değildir. Bu çalışmayı, AIB’nin etki mekanizmasını araştırmayı amaçladık.
Yöntem: Bu kadavra çalışmasında, AİB sol tarafa 20 mL ve sağ tarafa 10 mL olacak şekilde metilen mavisi ve radyoopak boya içeren ilaçla uygulandı. Blok uygulamasının ardından, her iki taraftaki yayılım üç boyutlu bilgisayarlı tomografi ile değerlendirildi. Daha sonra, pelvik anatomi konusunda deneyimli bir ortopedi cerrahı ve bir anatomist tarafından sistematik olarak katman katman kadavra diseksiyonu gerçekleştirildi.
Bulgular: Sol tarafta yayılım daha genişti ve özellikle kraniyal yönde ilerleme gözlendi. Buna karşılık, daha düşük hacmin uygulandığı sağ tarafta, enjeksiyon sıvısı iliak krest çevresindeki fasyal plan içinde sınırlı kaldı. Sol tarafta, iliakus kası üzerindeki fasyal planda yayılım gözlendi ve spinal sinirlerin kutanöz dalları boyandı. Ayrıca, ilioinguinal sinirde de boya izlendi. Sağ tarafta ise iliak krest üzerindeki kutanöz dallarda boya tutulumu saptandı.
Sonuç: Bu kadavra çalışması, AİB’nin düşük hacimle uygulandığında subkostal, iliohipogastrik ve ilioinguinal sinirlerin kutanöz dallarını etkili bir şekilde hedef aldığını göstermektedir.
Project Number
GOKAEK-2024/13.31
References
- Dissaux C, Ruffenach L, Bruant-Rodier C, George D, Bodin F, Rémond Y. Cleft Alveolar bone graft materials: literature review. Cleft Palate Craniofac J. 2022;59(3):336-346. doi:10.1177/10556656211007692.
- Morgan SJ, Jeray KJ, Saliman LH, Miller HJ, Williams AE, Tanner SL, et al. Continuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief. A randomized, double-blind study. J Bone Joint Surg Am. 2006;88(12):2606-2612. doi:10.2106/JBJS.E.00984.
- Cowan N, Young J, Murphy D, Bladen C. Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain. J Neurosci Nurs. 2002;34(4):205-210. doi:10.1097/01376517-200208000-00006.
- Black ND, Malhas L, Jin R, Bhatia A, Chan VWS, Chin KJ. The analgesic efficacy of the transversalis fascia plane block in iliac crest bone graft harvesting: a randomized controlled trial. Korean J Anesthesiol. 2019;72(4):336-343. doi:10.4097/kja.d.18.00352.
- Sondekoppam RV, Ip V, Johnston DF, Uppal V, Johnson M, Ganapathy S, Tsui BCH. Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study. Can J Anaesth. 2018;65(2):178-187. doi:10.1007/s12630-017-1021-y.
- Sowapark J, Sumphaongern T. Does Ultrasound-guided transversus abdominis plane block reduce donor site pain after harvesting anterior iliac crest bone grafts. J Oral Maxillofac Surg. 2021;79(2):333-342. doi:10.1016/j.joms.2020.09.017.
- Gürkan Y, Aksu C. Iliac crest bone graft donor site analgesia: a new indication for erector spinae plane block. Can J Anaesth. 2019;66(3):338-339. doi:10.1007/s12630-018-01276-6.
- Yörükoğlu HU, Cesur S, İzgin Avci İ, et al. Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block. BMC Anesthesiol. 2024;24(1):443. doi:10.1186/s12871-024-02829-7.
- Wong S, Hon S, Parry S, Boesch JM, Pearson E, de Miguel Garcia C. Image analysis comparison of nerve staining with food dye, methylene blue or tissue marker. Vet Anaesth Analg. 2024;51(1):36-43. doi:10.1016/j.vaa.2023.09.073.
- Howard MA, Dickie SR. Chapter 9: comprehensive trunk anatomy. İçinde: Neligan PC, ed. Plastic surgery. 3. Baskı, New York, NY: Elsevier Health; 2013:220–238.
- Birch R. Chapter 80: pelvic girdle, gluteal region and thigh. İçinde: Standring S, ed. Gray’s anatomy: the anatomical basis of clinical practice. 41. Baskı, Londra: Elsevier; 2016:1337–1375.
- Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med. 2010;35(5):436-441. doi:10.1097/aap.0b013e3181e66702.
- van Ramshorst GH, Kleinrensink GJ, Hermans JJ, Terkivatan T, Lange JF. Abdominal wall paresis as a complication of laparoscopic surgery. Hernia. 2009;13(5):539-543. doi:10.1007/s10029-009-0473-6.
- Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol. 2003;189(6):1574-1578. doi:10.1016/s0002-9378(03)00934-7.
Abstract
Objective: Anterior iliac crest (AIC) is frequently used as a donor site for various constructive surgeries. However, it is associated with severe postoperative pain that increases morbidity. To provide analgesia in the donor site with a low volume, a novel technique was described named anterior iliac block (AIB). It provides effective analgesia, but the mechanism of action is not clear. We designed this study to demonstrate the mechanism of AIB.
Methods: In this cadaveric study, AIB was performed with 10 mL (right side) and 20 mL (left side) of drug containing methylene blue and radiopaque dye on opposite sides. Following the block application, the spread on both sides was evaluated with 3D computed tomography. Afterwards, systematic layer-by-layer cadaver dissection was carried out by an orthopedic surgeon and anatomist experienced in pelvic anatomy.
Results: The spread was more extensive on the left side, it predominantly extended in a cranial direction. In contrast, on the right side, where a lower volume was administered, the injectate remained localized within the fascial plane surrounding the iliac crest. On the left side, spread was observed in the fascial plane above the iliacus muscle, and the cutaneous branches of spinal nerves were stained. Additionally, dye was observed in the ilioinguinal nerve. On the right side, dye staining in the cutaneous branches above the iliac crest was observed.
Conclusion: This cadaveric study demonstrates that AIB effectively targets the cutaneous branches of the subcostal, iliohypogastric, and ilioinguinal nerves with low volume.
Project Number
GOKAEK-2024/13.31
References
- Dissaux C, Ruffenach L, Bruant-Rodier C, George D, Bodin F, Rémond Y. Cleft Alveolar bone graft materials: literature review. Cleft Palate Craniofac J. 2022;59(3):336-346. doi:10.1177/10556656211007692.
- Morgan SJ, Jeray KJ, Saliman LH, Miller HJ, Williams AE, Tanner SL, et al. Continuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief. A randomized, double-blind study. J Bone Joint Surg Am. 2006;88(12):2606-2612. doi:10.2106/JBJS.E.00984.
- Cowan N, Young J, Murphy D, Bladen C. Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain. J Neurosci Nurs. 2002;34(4):205-210. doi:10.1097/01376517-200208000-00006.
- Black ND, Malhas L, Jin R, Bhatia A, Chan VWS, Chin KJ. The analgesic efficacy of the transversalis fascia plane block in iliac crest bone graft harvesting: a randomized controlled trial. Korean J Anesthesiol. 2019;72(4):336-343. doi:10.4097/kja.d.18.00352.
- Sondekoppam RV, Ip V, Johnston DF, Uppal V, Johnson M, Ganapathy S, Tsui BCH. Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study. Can J Anaesth. 2018;65(2):178-187. doi:10.1007/s12630-017-1021-y.
- Sowapark J, Sumphaongern T. Does Ultrasound-guided transversus abdominis plane block reduce donor site pain after harvesting anterior iliac crest bone grafts. J Oral Maxillofac Surg. 2021;79(2):333-342. doi:10.1016/j.joms.2020.09.017.
- Gürkan Y, Aksu C. Iliac crest bone graft donor site analgesia: a new indication for erector spinae plane block. Can J Anaesth. 2019;66(3):338-339. doi:10.1007/s12630-018-01276-6.
- Yörükoğlu HU, Cesur S, İzgin Avci İ, et al. Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block. BMC Anesthesiol. 2024;24(1):443. doi:10.1186/s12871-024-02829-7.
- Wong S, Hon S, Parry S, Boesch JM, Pearson E, de Miguel Garcia C. Image analysis comparison of nerve staining with food dye, methylene blue or tissue marker. Vet Anaesth Analg. 2024;51(1):36-43. doi:10.1016/j.vaa.2023.09.073.
- Howard MA, Dickie SR. Chapter 9: comprehensive trunk anatomy. İçinde: Neligan PC, ed. Plastic surgery. 3. Baskı, New York, NY: Elsevier Health; 2013:220–238.
- Birch R. Chapter 80: pelvic girdle, gluteal region and thigh. İçinde: Standring S, ed. Gray’s anatomy: the anatomical basis of clinical practice. 41. Baskı, Londra: Elsevier; 2016:1337–1375.
- Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med. 2010;35(5):436-441. doi:10.1097/aap.0b013e3181e66702.
- van Ramshorst GH, Kleinrensink GJ, Hermans JJ, Terkivatan T, Lange JF. Abdominal wall paresis as a complication of laparoscopic surgery. Hernia. 2009;13(5):539-543. doi:10.1007/s10029-009-0473-6.
- Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol. 2003;189(6):1574-1578. doi:10.1016/s0002-9378(03)00934-7.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Research Articles |
| Authors | |
| Project Number | GOKAEK-2024/13.31 |
| Publication Date | June 30, 2025 |
| Submission Date | May 13, 2025 |
| Acceptance Date | June 18, 2025 |
| Published in Issue | Year 2025 Volume: 8 Issue: 2 |
The articles in the Journal of "Acta Medica Nicomedia" are open access articles licensed under a Creative Commons Attribution-ShareAlike 4.0 International License at the web address https://dergipark.org.tr/tr/pub/actamednicomedia