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Related Experiment Videos

[The "3-in-1" block: myth or reality?].

C Cauhèpe1, M Oliver, R Colombani

  • 1Service d'Orthopédie-Traumatologie, CHU Purpan, Toulouse.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1989
PubMed
Summary

The "3 in 1" nerve block technique may not consistently reach the obturator nerve due to unpredictable local anesthetic spread. This impacts its suitability for hip surgeries requiring a complete regional block.

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Area of Science:

  • Anesthesiology
  • Anatomy
  • Radiology

Background:

  • The "3 in 1" technique aims for femoral, lateral femoral cutaneous, and obturator nerve blockade via a single femoral nerve sheath injection.
  • Winnie's 1973 description proposed this method for comprehensive regional anesthesia.

Purpose of the Study:

  • To evaluate the diffusion patterns of local anesthetics injected into the femoral nerve sheath for the "3 in 1" block.
  • To determine if the injected solution consistently reaches the obturator nerve.

Main Methods:

  • Anatomical dissection of 2 adult and 1 fetal cadavers.
  • Radiographic study involving injection of contrast medium into the femoral nerve sheath of adult volunteers.
  • Pelvic radiography and CT scans performed immediately and 30 minutes post-injection.

Main Results:

  • Two distinct, unpredictable diffusion patterns were observed, independent of injected volume.
  • Internal diffusion: anesthetic spread towards the psoas major muscle, potentially reaching all three target nerves.
  • External diffusion: anesthetic spread anterior to the iliacus muscle, not reaching the obturator nerve.

Conclusions:

  • The "3 in 1" block's efficacy for procedures requiring obturator nerve blockade (e.g., hip surgery) is uncertain due to inconsistent spread.
  • The technique may be suitable for surgeries involving only the anterior thigh and knee, where femoral and lateral femoral cutaneous nerve blockade is sufficient.

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