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Superior cluneal nerve dysfunction is a clinical diagnosis that can be supported by diagnostic nerve blocks. [ 1 ] The superior cluneal nerves were first described by Maigne et al. in 1989 as a source of low back pain.
The lumbar plexus block is an advanced technique indicated for hip, anterior thigh, and knee surgery. [54] The lumbar plexus is composed of nerves originating from L1 to L4 spinal roots such as the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves. [54]
The lumbar plexus is a web of nerves (a nerve plexus) in the lumbar region of the body which forms part of the larger lumbosacral plexus. It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve .
The ilioinguinal nerve is a branch of the first lumbar nerve (L1). It separates from the first lumbar nerve along with the larger iliohypogastric nerve.It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, and passes obliquely across the quadratus lumborum and iliacus.
The genitofemoral nerve is a mixed branch of the lumbar plexus derived from anterior rami of L1-L2.It splits a genital branch and a femoral branch.It provides sensory innervation to the upper anterior thigh, as well as the skin of the anterior scrotum in males and mons pubis in females.
The lateral cutaneous branch ("iliac branch") pierces the internal oblique muscles and the external oblique muscles immediately above the iliac crest. [4] It is distributed to the skin of the gluteal region, behind the lateral cutaneous branch of the subcostal nerve; the size of this branch bears an inverse proportion to that of the lateral cutaneous branch of the subcostal nerve.
Renal plexus: Lumbar splanchnic nerves: L1–2: Inferior mesenteric ganglia, ganglia of intermesenteric and hypogastric plexuses: Sacral splanchnic nerves: sacral part of sympathetic trunk: inferior hypogastric plexus and ganglia to the pelvic viscera: Pelvic splanchnic nerves: parasympathetic: S2–S4
CPN is generally performed complementary to nerve blocks, due to the severe pain associated with the injection itself. Neurolysis is commonly performed only after a successful celiac plexus block. [4] CPN and celiac plexus block (CPB) are different in that CPN is permanent ablation whereas CPB is temporal pain inhibition. [4]