Bloc du plexus lombaire par voie postérieure réalisé sous anesthésie générale : étude descriptive de 93 cas

Abstract

Objectives During many years the approach to the lumbar plexus has been the anterior paravascular technique described as a “3-1” block by Winnie. The posterior approach results in a complete block of the principal nerves of the lumbar plexus. The goal of the study was to evaluate the performance of the psoas compartment block with general anaesthesia. Study design Prospective, descriptive, non randomized study. Patients and methods Ninety-three patients scheduled for hip surgery were studied after informed consent. Demographic data, technical aspects of the puncture, complications, and intra- and postoperative analgesics were recorded. Results The block was performed by resident alone, senior alone, both in respectively 44%, 45, and 11% of cases. The mean duration of the procedure was 6 ± 3 min for the residents, 5 ± 2 min for the seniors, and 9 ± 4 min for both. The transverse process was reach in 72% of cases during the first approach, after reorientation of the needle in the others cases, except 3 failures of attempt. The lumbar plexus was assessed within 60–90 mm of depth, with a median of 75 mm. The motor response was mainly a femoral response; the minimal intensity of stimulation was ranged between 0.3 and 1 mA, with a median of 0.6 mA. The duration of analgesic block was 16.5 ± 4.5 hours, with a median of 18 hours. The morphine use during the first postoperative 24 hours was 8 ± 8 mg, with a median of 5.6 mg. No neurologic complication was recorded at discharge from the hospital. Conclusion The psoas compartment block with general anaesthesia have shown it feasibility and efficiency on intra- and postoperative analgesia during hip surgery.