The uterus is located in the lesser pelvis between the urinary bladder and the rectum. Although generally a midline structure, lateral deviations of the uterus are not uncommon. The broad ligaments extend from the uterus laterally to the pelvic side walls. They contain the fallopian tubes and vessels. The uterosacral ligaments serve to keep the uterus in an anterior position. They arise from the upper cervix posteriorly and extend to the fascia over the second and third sacral vertebrae. The round ligaments arise anterior to and below the fallopian tubes and cross the inguinal canal to end in the upper portion of the labia majora. (82)
By using a high frequency ultrasound probe the wrist is imaged by placing the probe transverse across dorsiflexed wrist. The median nerve and ulnar artery is identified. At the level of the distal wrist crease, the needle is passed into the skin superficial to the ulnar artery, penetrating the flexor retinaculum. The needle is advanced toward the median nerve. The steroid solution is injected just under the flexor retinaculum then retracted and redirected deeper to the ulnar side of the median nerve. This allows the median nerve to be completely surrounded with the steroid solution. [ 3 ]
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.