THE GLUTEUS DEEP INVESTING FASCIA COMPARTMENT BLOCK: A Novel Technique for Posterior Femoral Cutaneous Nerve Block

Abstract

Majaliwa Shabani,1 Seydina Alioune Beye,2,* Abdoulaye Traore,3 Pablo Echave,4,* Xavier Raingeval,5,* Daouda Coulibaly,6 Sophie Crespo7,* 1Health_unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Anesthesia Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée (ADRALE), Paris, France; 6Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 7Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of the Red Cross, HAMDALLAYE RUE 239, Postal Office Box: 58, Bamako, Mali, Email [email protected]: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique.Patients and Methods: Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine.Results: The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia.Conclusion: The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.Keywords: posterior femoral cutaneous nerve block, deep investing fascia, sciatic nerve block, gluteal deep investing fascia compartment block, GDIF block, CLEFT block

Keywords

• posterior femoral cutaneous nerve block
• deep investing fascia
• sciatic nerve block
• gluteal deep investing fascia compartment block.