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Pudendal Nerve Block in Children

Introduction The pudendal nerve is the major paired nerve of the perineum. It supplies sensation to the genitalia and perineal skin, and motor innervation to the external anal and external urethral sphincters. It is a branch of the sacral plexus (S2 through S4). With ultrasound, the nerve is most easily visualized in the pudendal canal, where it travels with the pudendal artery and vein. For adults,…

Thoracic Paravertebral Block

Introduction Thoracic paravertebral block (TPVB) is the technique of injecting local anesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramina. This produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous thoracic dermatomes (segmental thoracic anesthesia) both above and below the site of injection. It is effective in treating acute and chronic pain of unilateral origin from the chest…

Quadratus Lumborum Blocks

Clinical Anatomy/Sonoanatomy The quadratus lumborum (QL) is a posterior abdominal wall muscle that lies dorsolateral to the psoas major (PM) muscle. The QL muscle originates from the inner lip of the medial half of the iliac crest and inserts into the lower medial border of the last rib (usually the 12th rib). The medial border of the QL muscle attaches to the transverse processes of the…

Transversus Abdominis Plane Blocks

Anatomic Background The key to using transversus abdominis plane (TAP) blocks for abdominal surgery analgesia is a thorough understanding of the anatomy. The abdominal wall nerves from T7 to T9 emerge under the costal margin into the TAP and then penetrate the rectus abdominis muscle. Nerves T10 and T11 emerge from the end of the intercostal space, have a longer course within the plane, and then…

Transversus Thoracis Muscular Plane Block

The transversus thoracis muscular (TTM) plane block is a parasternal approach to block the anterior branches of the intercostal nerves (T2 through T6). This block can be effective for surgeries and fractures near or at the sternum (median sternotomy, thymectomy, mediastinoscopy, pericardial window, etc.). This block also may be useful for sub-xiphoid incisions. The Transversus Thoracis Muscle The transversus thoracis muscle arises from the posterior surface…

Pectoral Nerve Block (the Pecs Block)

The pectoral nerves are branches of the brachial plexus that innervate the pectoral muscles. The lateral pectoral nerve (C5, C6, C7) is often a branch of the lateral cord and innervates the pectoralis major muscle. The medial pectoral nerve (C8, T1) is often a branch of the medial cord and innervates both the pectoralis major and minor muscles. The lateral and medial pectoral nerves communicate via…

Posterior Femoral Cutaneous Nerve Block

The posterior femoral cutaneous nerve (PFCN), also referred to as the posterior cutaneous nerve of the thigh, is a sensory nerve that derives from the sacral plexus (S1, S2, and S3). The main descending branch of the PFCN is approximately 2 mm diameter in the proximal thigh and has a relatively straight course, which is nearly parallel to the sciatic nerve. The PFCN and the sciatic nerve…