Ultrasound-Guided Injections at the Lateral Femoral Cutaneous Nerve: The Inguinal Ligament as a Barrier

Background: Ultrasound-guided perineural injections at the lateral femoral cutaneous nerve (LFCN) may confirm the correct diagnosis and provide symptom relief in meralgia paresthetica. Although correct visualization of the nerve is generally described as feasible, failure rates of the procedure may be as high as 30%. Objectives: This study investigated the spread of injected fluids in ultrasound-guided perineural injections at the LFCN. The aim of the study was to evaluate whether the inguinal ligament impedes the distribution of injected fluids along the course of the LFCN. Study Design: We used a descriptive research design. Setting: Research was conducted at an anatomical research facility. Methods: In fresh, nonembalmed cadavers, 2 mL of ink were injected with ultrasound-guidance at the LFCN below the inguinal ligament. The course of the nerve was then dissected to show the extent of nerve staining. Results: Spread of the injected ink proximal to the inguinal ligament was found in 67.65% of specimens, while the ink did not pass the inguinal ligament in 32.35%. Concerning proximal spread, specimen body mass index was not of any relevance. Limitations: This cadaver study is only a simulation of the real clinical setting and does not allow any insight into the efficacy of the injection in living patients. Conclusions: The inguinal ligament is a barrier in the distribution of injected fluids in about one-third of specimens. This might be a major cause of failure in ultrasound-guided injections. The results from our study are in line with previously published failure rates and our findings might provide the anatomic basis to advance injection techniques.