RT Book, Section
A1 Marhofer, Peter
A1 Kapral, Stephan
A1 Sala-Blanch, Xavier
A2 Hadzic, Admir
SR Print(0)
ID 3502304
T1 Chapter 36. Three-in-One Block
T2 NYSORA Textbook of Regional Anesthesia and Acute Pain Management
YR 2007
FD 2007
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071449069
LK accessanesthesiology.mhmedical.com/content.aspx?aid=3502304
RD 2024/04/19
AB The  initial  description  of  the  3-in-1  block  was  published  by  Winnie  et  al.1  in  1973  involving  a  small  number  of  patients.  The  authors  postulated  that  a  block  of  the  entire  lumbar  plexus  can  be  accomplished  by  a  single  perivascular  injection  slightly  distal  to  the  inguinal  ligament.  Consequently,  a  single  injection  should  result  in  anesthesia  of  the  femoral,  the  lateral  femoral  cutaneous,  and  obturator  nerves.  Winnie  et  al.2,3  suggested  that  the  underlying  mechanism  of  this  regional  anesthetic  technique  should  be  a  cephalad  distribution  of  the  local  anesthetic  along  a  fascial  layer.  This  hypothesis,  however,  was  never  confirmed  clinically.  Moreover,  an  MRI  study  clarified  the  spread  of  local  anesthetic  after  an  inguinal  injection  of  local  anesthetic  lateral  to  the  femoral  artery4,5  and  concluded  that  the  distribution  of  local  anesthetic  follows  a  lateral  and  slightly  medial  direction,  but  never  a  cephalad  direction.  Figures  36–1  and  36–2  illustrate  that  the  spread  of  local  anesthetic  does  not  follow  a  proximal  direction.