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In this article, we present three cases of clunealgia admitted with low back pain. Their pain relieved with superior cluneal nerve block. The posterior side of the iliac crest, which is the location where the superior cluneal nerve passes, was identified using a high-frequency linear transducer. The drug injected separates the erector spinae muscle and thoracolumbar fascia and accumulates between these two structures. All patients were discharged with a complete pain relief. This report highlights the fact that superior cluneal nerve entrapment should be kept in mind in patients with low back pain and that ultrasound guidance can correctly identify the infiltration and eliminate anesthetization of other surrounding structures.

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OBJECTIVE: There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS: Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS: In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS: The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.

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BACKGROUND AND OBJECTIVE: Tuffier's line is the most used anatomic landmark in clinical practice. We aimed to compare the accuracy of Tuffier's line with a landmark that joins the two lowest points of the tenth rib on the flanks with the help of ultrasound. METHODS: A prospective, randomized, controlled, double-blinded trial was performed with 200 patients aged between 18 and 50. Patients taller than 180 cm or shorter than 150 cm, or with body mass index >30 kg/m2 were excluded. The first anesthesiologist examined Group T according to Tuffier's line and Group R according to the tenth rib line and marked L4-5. Only one anesthesiologist evaluated the marked level with ultrasound for accuracy of the anesthesiologist's examination. RESULTS: There was no difference between groups for demographic and surgical data (p > 0.05). However, we observed a significant difference between the two techniques for success rate (60% in group T vs. 74% in group R) at estimation of correct level (p < 0.05). There was no correlation between success of estimation and patients' demographic data. CONCLUSION: We conclude that the tenth rib line is better than Tuffier's line for accuracy with palpation. However, it must be confirmed by further studies including more than one examiner for palpation and also include different patient populations.