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The lumbar plexus is a web of nerves (a nerve plexus) in the lumbar region of the body which forms part of the larger lumbosacral plexus.It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve.
The ilioinguinal nerve is a branch of the first lumbar nerve (L1). It separates from the first lumbar nerve along with the larger iliohypogastric nerve.It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, and passes obliquely across the quadratus lumborum and iliacus.
The lumbar plexus block is an advanced technique indicated for hip, anterior thigh, and knee surgery. [54] The lumbar plexus is composed of nerves originating from L1 to L4 spinal roots such as the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves. [54]
The first three lumbar nerves, and the greater part of the fourth together form the lumbar plexus. The smaller part of the fourth joins with the fifth to form the lumbosacral trunk, which assists in the formation of the sacral plexus. The fourth nerve is named the furcal nerve, from the fact that it is subdivided between the two plexuses.
The lateral cutaneous branch ("iliac branch") pierces the internal oblique muscles and the external oblique muscles immediately above the iliac crest. [4] It is distributed to the skin of the gluteal region, behind the lateral cutaneous branch of the subcostal nerve; the size of this branch bears an inverse proportion to that of the lateral cutaneous branch of the subcostal nerve.
The anterior divisions of the lumbar nerves, sacral nerves, and coccygeal nerve form the lumbosacral plexus, the first lumbar nerve being frequently joined by a branch from the twelfth thoracic. For descriptive purposes this plexus is usually divided into three parts: lumbar plexus; sacral plexus; pudendal plexus
The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus; the branch from the third is the largest, while that from the second is often very small.
CPN is generally performed complementary to nerve blocks, due to the severe pain associated with the injection itself. Neurolysis is commonly performed only after a successful celiac plexus block. [11] CPN and celiac plexus block (CPB) are different in that CPN is permanent ablation whereas CPB is temporal pain inhibition. [11]