3 – Scanning technique
Place the patient in the lateral decubitus position
Place a low-frequency curved array probe in the axial plane in the flank just cranial to the iliac crest
The muscles of the abdominal wall are visualized (see next page). The probe is moved dorsal until the quadratus lumborum is seen medial to the aponeurosis of the transversus abdominis
With a slight caudal tilt of the probe, the body and transverse process (TP) of vertebral body L4 can be seen surrounded by the “shamrock muscles” (see next page)
The lumbar plexus is visualized anterior to the TP (see second next page)
The needle is inserted from the back of the patient with in-plane technique and the needle tip is guided by ultrasound and electrical nerve stimulation to the target lumbar plexus (see third next page). Inject 20-30 mL of local anaesthetic.
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