Superior Gluteal Nerve Block for Pelvic Surgery

 

Background:

The origin of the superior gluteal nerve arises from the L4, L5, and S1 nerve roots in the sacral plexus. The superior gluteal nerve plays a significant role in the innervation of the pelvis by supplying multiple muscles used for gait stability. These muscles include the gluteus minimus, gluteus medius,tensor fasciae latae, and significant portions of the piriformis muscle. [1,2] This coalition of pelvic musculature plays a pivotal role in hip abduction and hip extension, thereby allowing stabilization of the pelvis throughout gait.

The anatomy of the superior gluteal nerve in relation to the pelvic musculature is also very important when considering it for regional anesthesia. First, it is the only nerve that exits the greater sciatic foramen superior to the piriformis muscle, thereby allowing easier visualization under ultrasound compared to other pelvic nerves such as the pudendal and inferior gluteal nerves. [1] Second, the nerve travels anterolaterally in the fascial plane between gluteus minimus and gluteus medius and is often accompanied by the superior gluteal artery. Finding these anatomical structures allow for a more reliable method to accomplish a regional anesthetic, as the nerve is often not directly visible due to its relative size and depth. [1]