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The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block's efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon's perspective on nerve blocks for hip fractures. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain often remains troublesome for the patients, if not adequately managed. Various modalities have been tried to keep the patient pain free. Regional nerve blocks under ultrasound guidance have recently gained much popularity. We aimed to compare the pain relief outcomes after hip replacement surgery by continuous Pericapsular Nerve Group Block (PENG Block) in combination with lateral femoral cutaneous nerve (LFCN) block under the guidance of ultrasound versus patient-controlled intravenous analgesia (PCA). Methodology: Sixty patients, who underwent hip surgery at E University Hospital, Hanoi, Vietnam, from August 2021 to August 2022, were randomly allocated to one of the two groups: group of patients with pain relief with PENG block in combination with LFCN block (PENG group) and the group of patients with patient-controlled intravenous analgesia (PCA group). Outcomes regarding clinical parameters and pain scores on Visual Analogue Scale (VAS), from the initiation of the blocks or the PCA (H0) to 72 h (H72) were recorded and compared. Results: Sixty patients were included in this study. The average VAS scores at rest in both groups was at low pain level (VAS < 4). The average VAS score in both of the groups at most of the time of the study did not have a statistically significant difference. The VAS on movement at the time points H18, H21, H24, H30, H36, H48, H72 of the PENG group was lower than that of the PCA group and the difference was statistically significant between the two groups (P < 0.05). The rate of vomiting/nausea of patients in the PCA group was significantly higher than in the PENG group (P = 0.006). Conclusion: Pericapsular nerve block combined with lateral femoral cutaneous nerve block offers prolonged pain relief when compared with traditional patient-controlled intravenous analgesia in postoperative pain relief after hip replacement, and is associated with lower frequency of vomiting/nausea. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are shortlived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to explore morphological variations of the lateral femoral cutaneous nerve (LFCN) as well as its connections within the lumbar plexus, offering insights for clinical assessments and surgical considerations in lumbar spine approaches. The goal is to enhance understanding of LFCN anatomy, particularly its origin and intra-abdominal course, in diverse anatomical configurations. Methods: The study employed detailed stratigraphic dissection techniques on 80 cadavers to investigate the morphological variations of the LFCN and its connections within the lumbar plexus. Cadaveric specimens were dissected to assess the origin of LFCN at different levels and potential differences in its course, providing valuable insights for clinical and surgical implications. Results: The study revealed significant anatomical variability in the lateral femoral cutaneous nerve (LFCN) across specimens. The origin of LFCN, typically from L2-L3 lumbar roots, exhibited diverse patterns, with variations observed in 48.3% of cases. Notably, the L2 root dominated in 81.25% of instances, and origin solely from L2 root constituted 11.5% of specimens, higher than previously reported rates. Unusual patterns included LFCN starting from femoral nerve in 7.5 % of specimens, highlighting the intricate nature of lumbar plexus anatomy. These findings contribute to a nuanced understanding of LFCN variations and their clinical implications. Conclusion: The study underscores the substantial morphological alterations of the lateral femoral cutaneous nerve, emphasizing the need for clinicians to be cognizant of diverse patterns in lumbar plexus anatomy. These findings have important implications for surgical interventions and neurologic assessments involving the lateral femoral cutaneous nerve. [ABSTRACT FROM AUTHOR]

Abstract Objective The INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries. Patients and methods A retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed. Results There was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P

The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future. [ABSTRACT FROM AUTHOR]

Objective: The INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries. Patients and methods: A retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed. Results: There was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P < 0.05). In contrast, the M-INFIX group had statistically higher operative time, intraoperative bleeding, and Matta score than the C-INFIX group (P < 0.05). Conclusion: This study was based on a modified application of the surgical experience with C-INFIX and showed better clinical outcomes in terms of complication rates and quality of repositioning than the conventional surgical approach. These findings indicate that further analytical studies of this study would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: Typically, the lateral femoral cutaneous nerve, also known as the lateral cutaneous nerve of the thigh (LCNT), runs under the inguinal ligament near the anterior superior iliac spine, runs anterior to the sartorius muscle and then divides into two terminal branches, i.e., anterior and posterior, which provide sensory innervation to the anterior and lateral thigh. This report describes an unusual anatomic variant in which terminal branches of the LCNT pierced the sartorius muscle. Case description: Dissection involved formalin-fixed right isolated lower limb. The procedure revealed anatomical variation of the LCNT. The nerve's division level into anterior and posterior branches was at the level of the inguinal ligament under the sartorius muscle. The posterior branch of the LCNT was directly adjacent to the anterior superior iliac spine. After a short course, this branch emerged from under the sartorius muscle lateral border 39 mm distally (in a straight line) to the inguinal ligament. The nerve's anterior branch pierced the sartorius muscle. It exited on the anterior surface of the muscle, 72 mm (in a straight line) from the inguinal ligament. The innervation territory of both branches was typical. We found no other anatomical variations of lumbar plexus branches. Conclusions: The LCNT terminal branches may show anatomic variations, which clinicians should consider during neurological assessments of nerve lesions. Deviations from the typical course of nerves should also be kept in mind when conducting surgical interventions.

Introduction: Anatomical variations of the nerves derived from the lumbar plexus are common and clinically valid. Therefore, this report aims to present the coexisting anatomical variations of the lateral femoral cutaneous and genitofemoral nerves. Case description: During routine dissection of an isolated male left lower limb (fixed in 10 % formalin solution), atypical arrangements of the lateral femoral cutaneous and genitofemoral nerves were found. The lateral femoral cutaneous nerve division level into anterior and posterior branches was high, above the inguinal ligament. Both branches passed beneath the inguinal ligament at the midpoint of the distance between the anterior superior iliac spine and the femoral artery. The anterior branch of the lateral femoral cutaneous nerve was better developed and had a greater diameter than the posterior branch. The femoral branch of the genitofemoral nerve was absent and partially replaced by the most medial branch derived from the anterior division of the lateral femoral cutaneous nerve. Conclusions: The lateral femoral cutaneous and genitofemoral nerves can show anatomic variability, which should be remembered during clinical assessments of nerve lesions and while performing surgical interventions.

The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (

Objective: A recent spurt in incidence of meralgia paresthetica to 0.1- 81% due to minimally invasive anterior approach to hip joint has resulted in reinterest in anatomy of lateral femoral cutaneous nerve (LFCN). Familiarity with variations in the course of LFCN will reduce the morbidity associated with orthopedic procedures around the anterior superior iliac spine (ASIS) and inguinal ligament (IL). Methods: Twenty five adult human formalin embalmed cadavers were dissected. Course and relations of nerve to ASIS, IL and sartorius muscle was noted, distance of nerve from ASIS at IL was measured and statistically analyzed. Results: Mean distance of LFCN from ASIS at IL was 1.73±1.15 cm. Differences between two sides and sexes was statistically not significant (p=0.51 and p=0.96 respectively). Inferomedial to ASIS, 94% of LFCNs crossed IL with 92% of them present within 4 cm medial to ASIS. Majority of LFCNs (90%) exited pelvis and entered thigh posterior to IL. Out of these nerves 48% were single trunks on entry into thigh, then bifurcated into anterior and posterior branches. Remaining LFCNs bifurcated proximal to IL or at level of IL. Trifurcations were seen in 6% while a rare case of pentafication was observed. In 66% main trunk/branches were present in intermuscular cleft between sartorius muscle and tensor fascia lata. Conclusions: Care should be exercised by surgeons while dissecting around IL as more than half of nerves are liable to be injured during operative procedures. This would help in better anticipation of problem, acceptance and reducing litigation. [ABSTRACT FROM AUTHOR]

Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and =13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance =13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve -to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance =13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was =13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders. [ABSTRACT FROM AUTHOR]

Background: Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. Methods: This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. Results: No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Conclusions: Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested.

Abstract Background An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between the sartorius and tensor fasciae latae muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Anatomical studies have revealed that the LFCN courses between the sartorius and tensor fasciae latae muscles. When the LFCN branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle, it is called the fan type. Studies suggest that damage to the fan type LFCN is unavoidable during conventional fasciotomy. We previously demonstrated that injury to non-fan variation LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury to non-fan variation LFCN. LFCN injury is rarely reported in the anterolateral approach, which involves incision of fascia further away than the DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. Methods We will conduct a prospective, randomized, controlled study. All patients will be divided into a fan variation and a non-fan variation group using ultrasonography before surgery. Patients with non-fan variation LFCN will receive conventional fasciotomy and lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint will be the presence of LFCN injury during an outpatient visit using a patient-based questionnaire. The secondary endpoints will be assessed based on patient-reported outcomes at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire, and the Forgotten-Joint Score-12. Discussion We hypothesize that the incidence of LFCN injury due to DAA-THA is reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA and improve patient satisfaction. Trial registration UMIN Clinical Trials Registry, UMIN000035945 . Registered on 20 February, 2019.

Background: Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. Methods: This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. Results: No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Conclusions: Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested. [ABSTRACT FROM AUTHOR]

Purpose of Review Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options. Recent Findings Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that's universally effective for treating all patients with MP. Summary Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants. [ABSTRACT FROM AUTHOR]

Abstract Background Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale. Results There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure. Conclusions Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica. Trial registration : NCT04499911 . Registered 5 August 2020—retrospectively registered.

Abstract Background Lateral femoral cutaneous nerve (LFCN) injury after total hip arthroplasty causes patient dissatisfaction. This cadaveric study aimed to assess the risk for LFCN injury after the direct anterior approach (DAA) and anterolateral supine approach (ALS) with a focus on the anatomical variations of the LFCN. Methods Thirty-seven hemipelves from 20 formalin-preserved cadavers (10 males and 10 females) were dissected to identify the LFCN, evaluate variations, and measure the distance from the LFCN to each approach. The LFCN was classified as classical, late, multi trunk, or primary femoral. Results There were no significant variations in the LFCN between the sexes. The distance from the LFCN to DAA incision (10 [0–17.8] mm) was significantly less than that from the LFCN to ALS incision (27 [0–40] mm); moreover, 64.9% of DAA incisions crossed the LFCN. The classical type LFCN was closest to the DAA incision. The DAA incision most frequently crossed the LFCN at the proximal third, and the frequency of intersection of the LFCN and DAA incisions decreased by 25% by a 10-mm shortening of the DAA proximal incision. In contrast, 27% of ALS incisions crossed the LFCN. Multi trunk type LFCN was closest to the ALS incision. There were no significant differences between each approach and LFCN variations, and the frequency of intersection of the LFCN and ALS incisions decreased by 20% by a 10-mm shortening of the ALS proximal incision. Conclusions The intersection rates between the LFCN and the DAA and between the LFCN and the ALS were approximately 65 and 30%, respectively. Approximately 20–25% of these injuries may be avoidable by a 10-mm shortening of the proximal incision.

Abstract Background The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

Background: An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between the sartorius and tensor fasciae latae muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Anatomical studies have revealed that the LFCN courses between the sartorius and tensor fasciae latae muscles. When the LFCN branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle, it is called the fan type. Studies suggest that damage to the fan type LFCN is unavoidable during conventional fasciotomy. We previously demonstrated that injury to non-fan variation LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury to non-fan variation LFCN. LFCN injury is rarely reported in the anterolateral approach, which involves incision of fascia further away than the DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury.Methods: We will conduct a prospective, randomized, controlled study. All patients will be divided into a fan variation and a non-fan variation group using ultrasonography before surgery. Patients with non-fan variation LFCN will receive conventional fasciotomy and lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint will be the presence of LFCN injury during an outpatient visit using a patient-based questionnaire. The secondary endpoints will be assessed based on patient-reported outcomes at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire, and the Forgotten-Joint Score-12.Discussion: We hypothesize that the incidence of LFCN injury due to DAA-THA is reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA and improve patient satisfaction.Trial Registration: UMIN Clinical Trials Registry, UMIN000035945 . Registered on 20 February, 2019. [ABSTRACT FROM AUTHOR]

Background: Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale. Results: There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure. Conclusions: Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica. Trial registration : NCT04499911. Registered 5 August 2020—retrospectively registered. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica (MP), also known as Bernhardt–Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 ± 0.62 and the postoperative VAS value at the sixth month was 1.17 ± 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.

Background: Lateral femoral cutaneous nerve (LFCN) injury after total hip arthroplasty causes patient dissatisfaction. This cadaveric study aimed to assess the risk for LFCN injury after the direct anterior approach (DAA) and anterolateral supine approach (ALS) with a focus on the anatomical variations of the LFCN. Methods: Thirty-seven hemipelves from 20 formalin-preserved cadavers (10 males and 10 females) were dissected to identify the LFCN, evaluate variations, and measure the distance from the LFCN to each approach. The LFCN was classified as classical, late, multi trunk, or primary femoral. Results: There were no significant variations in the LFCN between the sexes. The distance from the LFCN to DAA incision (10 [0–17.8] mm) was significantly less than that from the LFCN to ALS incision (27 [0–40] mm); moreover, 64.9% of DAA incisions crossed the LFCN. The classical type LFCN was closest to the DAA incision. The DAA incision most frequently crossed the LFCN at the proximal third, and the frequency of intersection of the LFCN and DAA incisions decreased by 25% by a 10-mm shortening of the DAA proximal incision. In contrast, 27% of ALS incisions crossed the LFCN. Multi trunk type LFCN was closest to the ALS incision. There were no significant differences between each approach and LFCN variations, and the frequency of intersection of the LFCN and ALS incisions decreased by 20% by a 10-mm shortening of the ALS proximal incision. Conclusions: The intersection rates between the LFCN and the DAA and between the LFCN and the ALS were approximately 65 and 30%, respectively. Approximately 20–25% of these injuries may be avoidable by a 10-mm shortening of the proximal incision. [ABSTRACT FROM AUTHOR]

COVID-19 critically ill patients usually require prone positioning for the treatment of respiratory failure caused by Acute Respiratory Distress Syndrome (ARDS). Prone position provides a better ventilation-perfusion compatibility, resulting in a significant improvement in oxygenation and a decrease in mortality, but prolonged prone positioning may cause Meralgia Paresthetica (MP), one of the most common mononeuropathies of the lower limb. The early diagnosis of MP is crucial to avoid a permanent damage with pain and disability, and to start immediately the correct treatment. In this article, we report a rare case of MP in a critically ill COVID-19 patient with ARDS, with the main aim to create awareness for MP among the medical team working.

Background and objectives: Based on the preparation of 20 formalin-fixed anatomical cadavers, the feasibility of the anterior, minimally invasive approach to the hip joint was investigated in each side of the body. The hypothesis of the study was that the Lateral Femoral Cutaneous Nerve can be spared under the use of this approach. Materials and Methods: The anterior approach to the hip was performed via an incision of 8 cm. The position of the nerve was noticed in relation to the skin incision, and the distance was measured in milli-meters. The nerves main, gluteal and femoral trunk were distinguished and investigated for injury. Results: No injury of the main trunk was noticed. The average distance of the main trunk to the skin incision was 14.9 and 15.05 mm in the medial direction, respectively (p < 0.001). Injury of the gluteal branch has to be considered at an overall rate of 40%. Conclusions: The anterior, minimally invasive approach to the hip joint can be performed without injury of the Lateral Femoral Cutaneous Nerve. [ABSTRACT FROM AUTHOR]

Background: The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods: A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results: There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions: LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided. [ABSTRACT FROM AUTHOR]

The variability in the formation of Ilioinguinal nerve has been documented in the literature especially related to iliohypogastric nerve. But so far very few cadaveric studies have been documented on variation in the branches of ilioinguinal nerve. A case presented which demonstrates aberrancy of its anatomic position. Although the course of ilioinguinal nerve is well known, nostudies have documented the variation of its course in relation to lateral femoral cutaneous nerve. This case report serves as a warning to the surgeon to be aware of such bizarre presentation since the consequences of iatrogenic injury to such structures may be serious. [ABSTRACT FROM AUTHOR]

The variability in the formation of Ilioinguinal nerve has been documented in the literature especially related to iliohypogastric nerve. But so far very few cadaveric studies have been documented on variation in the branches of ilioinguinal nerve. A case presented which demonstrates aberrancy of its anatomic position. Although the course of ilioinguinal nerve has been well known, nostudies or report have demonstrated a course in relation to lateral femoral cutaneous nerve. This case report serves as a warning to the surgeon to be aware of such bizarre presentation since the consequences of iatrogenic injury to such structures may be serious.

Objective: Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). We report a rare case of MP after microvascular decompression (MVD) surgery in the park-bench position in a patient with hemifacial spasm. Case: The patient was a nondiabetic 46-year-old woman (height: 155 cm, weight: 42 kg) who consumed alcohol infrequently. After a first MVD for right hemifacial spasm, the symptom recurred and she underwent a second MVD procedure in the park-bench position, after which hemifacial spasm resolved. However, she reported right anterolateral thigh pain and dysesthesia without motor weakness. The pain was limited to the LFCN area, and a pelvic compression test elicited a positive Tinel-like sign. Our preliminary diagnosis was MP. Because conservative therapy was ineffective, she underwent LFCN block 9 months after the second MVD procedure. Her pain improved dramatically and we made a definitive diagnosis of MP. There has been no recurrence after 30 months of observation, although she reported persistent mild dysesthesia in the LFCN area. Conclusion: MP is a rare complication after MVD surgery in the park-bench position. LFCN block can resolve symptoms and hasten diagnosis. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica (MP), also known as Bernhardt–Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 ± 0.62 and the postoperative VAS value at the sixth month was 1.17 ± 0.72. A significant reduction in the pain was shown ( p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries. [ABSTRACT FROM AUTHOR]

Background Meralgia paresthetica is a condition caused by entrapment of the lateral femoral cutaneous nerve that leads to paresthesia along the anterolateral portion of the thigh. Because of advancements in neuromodulation, peripheral nerve stimulation (PNS) has been considered a new treatment option for meralgia paresthetica. Newer PNS technology targets peripheral nerves directly yet in a minimally invasive manner. We report a case in which a PNS device provided more than 12 months of complete pain relief in a patient with meralgia paresthetica and helped the patient avoid a neurolysis procedure. Case Presentation A 57-year-old male presented to clinic with a 6-year history of "painful numbness [and] burning" along the right lateral thigh. He rated his pain as 8 out of 10, which decreased to a rating of 2 out of 10 with the use of gabapentin, but unwanted side effects motivated him to seek alternative treatment. On the basis of his history, physical exam, and imaging results, he was diagnosed with meralgia paresthetica. He was offered neurolysis; however, after seeing a pain specialist, he agreed to the implantation of a SPRINT peripheral nerve stimulator. After the implantation procedure, his pain reduced to 0 out of 10, and his quality of life improved, with better sleep and less somnolence. The device was removed after 60 days, as planned. He continued to have complete resolution of pain at 12 months after the date of device implantation. Conclusion With recent advancements, PNS can be used to treat meralgia paresthetica in an effective yet minimally invasive manner. As newer PNS technology becomes more familiar to physicians and pain specialists, it is likely to be used as a mainstay treatment for meralgia paresthetica. [ABSTRACT FROM AUTHOR]

The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162., Competing Interests: Disclosures Dr. Mahan reported personal fees from joimax and Renerva, and grants from Boston Scientific, Orthofix, and Nevro, outside the submitted work.Dr. Mahan reported personal fees from joimax and Renerva, and grants from Boston Scientific, Orthofix, and Nevro, outside the submitted work., (© 2024, The Authors.)

Introduction: Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneous nerve. It is usually idiopathic and can be treated with drugs used for neuropathic pain such as pregabalin, gabapentin, and amitriptyline. Objectives: This study was done to study the effect of triamcinolone acetonide on drug refractory MP. Methods: This study was a retrospective case file review. Results: Eight patients were treated with local injections of triamcinolone. The patients were followed up for a period of 4 months to 54 months. There was significant symptomatic improvement with six patients having complete improvement and all patients reporting >50% improvement. Patients who had recurrence of symptoms on follow up received up to four injections as per their requirement and repeated injections also produced >50% symptom relief. Conclusion: Triamcinolone acetonide injected locally seems to be an effective and safe treatment for refractory MP. A randomized control trial has been planned to look for efficacy and safety.

Background and objectives: Based on the preparation of 20 formalin-fixed anatomical cadavers, the feasibility of the anterior, minimally invasive approach to the hip joint was investigated in each side of the body. The hypothesis of the study was that the Lateral Femoral Cutaneous Nerve can be spared under the use of this approach. Materials and Methods: The anterior approach to the hip was performed via an incision of 8 cm. The position of the nerve was noticed in relation to the skin incision, and the distance was measured in millimeters. The nerves main, gluteal and femoral trunk were distinguished and investigated for injury. Results: No injury of the main trunk was noticed. The average distance of the main trunk to the skin incision was 14.9 and 15.05 mm in the medial direction, respectively (p < 0.001). Injury of the gluteal branch has to be considered at an overall rate of 40%. Conclusions: The anterior, minimally invasive approach to the hip joint can be performed without injury of the Lateral Femoral Cutaneous Nerve.

Objective With advances in peripheral nerve stimulation technology, there has been an emergence of new minimally invasive techniques to provide neurostimulation therapies for chronic pain. This technical note describes the utilization of ultrasonography for percutaneous placement of peripheral nerve stimulation leads at the sciatic, femoral, and lateral femoral cutaneous nerves. Methods Ultrasound can be utilized to localize a specific nerve, view neighboring soft tissue anatomy, and plan a needle trajectory. Various ultrasound techniques and transducer orientations allow for multiple options for lead placement relative to the targeted nerve. Conclusions The option of ultrasound-guided percutaneous technique for neurostimulation lead placement allows this treatment modality to be made available to more patients with chronic pain in specific nerve distributions. [ABSTRACT FROM AUTHOR]

Background. Meralgia paresthetica is a term used to describe a clinical pain syndrome related to the compression or irritation of the lateral femoral cutaneous nerve (LFCN). The LFCN is a pure sensory nerve that is susceptible to compression injury. The most common compression locations are: as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. Methods. This case series is a retrospective single-center review of six patients with medically intractable meralgia paresthetica who were treated with radiofrequency ablation. To be considered for radiofrequency ablation, the patient must have been unsuccessful with medical management alone for more than two months and have a clinical diagnosis of meralgia paresthetica. Temporary relief of pain of 50% or greater was considered a positive result. Average pain scores were measured pre- and postprocedure, along with one-, two-, three-, and six-month intervals postoperation. Results. All patients demonstrated immediate relief in self-reported pain scores, averaging a 75.5% reduction in pain. At the one-, two-, three-, and six-month follow-ups, patients averaged a reduction of 60.0%, 58.0%, 51.4%, and 40.5%, respectively. Both the postop and one-month follow-up pain scores were lower, statistically significantly so (P < 0.05), whereas the two-, three-, and six-month follow-ups were not statistically different from pretreatment scores. Conclusions. Although our study was small, radiofrequency ablation showed a clear reduction in average pain scores in a subset of patients who had failed standard medical therapy with a reduction in pain at one-month follow-up with relief of symptoms sometimes lasting longer than 12 months. [ABSTRACT FROM AUTHOR]

Ultrasound examination of femoral, saphenous and lateral cutaneousfemoral nerves was performed in 25 healthy volunteers(50 extremities) with normal body weight, at mean age374.3 years. Examination procedure and topography of theinvestigated nerves are described. The nerves identification ispossible due to anatomical landmarks. Femoral and lateralfemoral cutaneous nerves were visualized in all cases. Cutaneousnerves are available for proper visualization in subjects with normallydeveloped subcutaneous fat. Structural features of nervesdidnt show statistically significant sexual and bilateral distinctions.Sonography is an accessible method for examination ofcertain lumbar plexus nerves.

Meralgia paresthetica is a neuropathy of the lateral femoral cutaneous nerve. Traditionally, the diagnosis is based on classical symptoms and signs. In cases where there is a diagnostic dilemma, the role of magnetic resonance imaging has been to exclude other causes for the patient’s presentation, as the small extraspinal peripheral nerves were not well visualised at imaging. The development of 3-Tesla magnetic resonance neurography, however, has made pathology of these nerves more conspicuous.

Meralgia paresthetica (MP) is a sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN). MP has rarely been reported after a femoral intervention approach. We report a case of bilateral meralgia paresthetica following bilateral femoral cannulation. A 64-year-old male received cardiac catheterization and treatment via a bilateral femoral vein. After cardiac catheterization, the patient presented with paresthesia in the anterolateral aspect of the bilateral thigh. After performing nerve conduction studies and electromyography, he was diagnosed as MP. Although a bilateral LFCN lesion following a femoral approach is very rare, MP might require caution regarding potential variations in LFCN when performing the femoral approach.

Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and ≥13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance ≥13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve-to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance ≥13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was ≥13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders., Competing Interests: None.

Background: Total hip arthroplasty (THA) employing the direct anterior approach (DAA) is increasingly performed as a less invasive procedure with faster recovery than other approaches. Unlike other approaches, the skin incision is made on the lateral thigh, distal to the inguinal ligament. However, the effectiveness of ultrasound-guided lateral femoral cutaneous nerve (LFCN) block for postoperative analgesia after THA using DAA has not been investigated.We hypothesized that ultrasound-guided LFCN block using DAA would reduce postoperative pain after THA., Methods: A prospective, randomized, observer-blinded controlled trial was conducted. The 92 patients included were divided into two groups: those who received only femoral nerve block (FNB group) and those who received femoral nerve block and LFCN block with 10mL of 0.25% levobupivacaine (FNB + LFCNB group). Both groups received intravenous patient-controlled analgesia (fentanyl) postoperatively. A numerical rating scale was used to quantify pain at 3 and 48 h postoperatively., Results: There was no significant difference in pain at rest and during movement between the FNB and FNB + LFCNB groups (at rest: Z = -1.6814, p=0.0927; during on movement: Z = -0.9677, p=0.9487). There was also no significant difference in pain severity at rest and during movement between the FNB and FNB + LFCNB groups postoperatively., Conclusions: LFCNB did not improve postoperative pain relief in patients undergoing THA with DAA., Competing Interests: The authors declare no competing or conflicts of interest in this work., (© 2023 The Juntendo Medical Society.)