Study on the Efficacy of Infiltration of Upper Cluneal Nerves in Chronic Pain Related to Cluneal Syndrome
Cluneal Syndrome, Nerve Entrapment Syndrome
About this trial
This is an interventional treatment trial for Cluneal Syndrome focused on measuring Superior cluneal nerve entrapment, Chronic Low-back Pain, Injection Site Infiltration, Local anesthetic, Pain, Cluneal nerve block
Eligibility Criteria
Inclusion Criteria:
- Patient signed Inform Consent
- Patient diagnosed with unilateral or bilateral superior cluneal syndrome :
Diagnostic points will be :
- a maximum pain at the trigger point on the back iliac crest, approximately 7 cm from the median line and 4.5 cm from the poster superior iliac crest. Palpation on this point causes pain reminding the patient's long-term pain),
- Palpation "rolled-palpated" at the buttocks provokes either pain, paraesthesia, or discomfort.
- The criteria of facial syndrome, sacro-iliac syndrome or radiculopathy are excluded.
- Low back pain during back movements.
Exclusion Criteria:
- Pain not associated to superior cluneal syndrome.
- Infection at the puncture point.
- Pain of suspected neoplastic origin.
- Allergy to local anaesthetics.
- Refusal of the patient
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Physiological serum Group
Ropivacaine Group
The cluneal nerve block is performed under ultrasound using the Thomas Dahl Nielsen and Thomas Fichtner Bendtsen method. The patients are placed in ventral decubitus. A sensor of high linear frequency is moved toward the middle and posterior to where the aponeurosis of the transverse muscle and the thoraco-lumbar fascia meet, following the appearance of the thoracolumbar fascia and then the appearance of the posterior ilio-costalis muscle under the fascia lumbar area. The infiltration is carried out "in-plane", with a lateral towards the median axis direction, in a way, that it penetrates perpendicularly the fascia The physiological serum (NaCl 0.9%) will be injected, on each side, into the aponeurosis and the muscle in the area where the superior cluneal nerves pass. An easy separation of the thoraco- lumbar fascia and the ilio-costalis muscle is achieved during injection by slightly raising the needle towards the median axis as the space opens up gradually.
The cluneal nerve block is performed under ultrasound using the Thomas Dahl Nielsen and Thomas Fichtner Bendtsen method. The patients are placed in ventral decubitus. A sensor of high linear frequency is moved toward the middle and posterior to where the aponeurosis of the transverse muscle and the thoraco-lumbar fascia meet, following the appearance of the thoracolumbar fascia and then the appearance of the posterior ilio-costalis muscle under the fascia lumbar area. The infiltration is carried out "in-plane", with a lateral towards the median axis direction, in a way, that it penetrates perpendicularly the fascia The local anaesthetic (Ropivacaine) will be injected into the aponeurosis and the muscle in the area where the superior cluneal nerves pass. An easy separation of the thoraco- lumbar fascia and the ilio-costalis muscle is achieved during injection by slightly raising the needle towards the median axis as the space opens up gradually.