Abstract
BackgroundLumbar erector spinae plane block (L-ESPB) is being used in fractured hip patients for the postoperative pain relief and as a sole anesthetic technique. Various clinical and cadaveric studies have differences of opinion about its mechanism of action and pathways of local anesthetic spread; however, the role of lumbar plexus (LP) in the mechanism of action is still not considered. In our clinical experience, we observed that the action on LP could be a pathway for the analgesic action of local anesthetic along with paravertebral spread.Case presentationWe report here three cases of the fractured hip who were given L-ESPB for postoperative pain management. The radiological examination was done after injection of non-ionic contrast to know the spread of local anesthetic. In two cases, the contrast spread was seen towards LP and in one case spread of contrast was observed towards the paravertebral area.ConclusionsEffect of local anesthetic on the lumbar plexus is one of the plausible pathways in L-ESPB for its analgesic mechanism of action.
Highlights
Lumbar erector spinae plane block (L-ESPB) is being used in fractured hip patients for the postoperative pain relief and as a sole anesthetic technique
We report here three cases of hip surgery where continuous lumbar ESPB with catheter was used for the postoperative pain relief
After contacting the transverse process (TP), 2 ml saline was injected through the needle and correct needle placement was ascertained by lifting of erector spinae muscle (ESM) and linear caudal-cranial spread of saline underneath the ESM (Fig. 1A, B)
Summary
This case report presents a series of three patients where clinical effect of L-ESPB was correlated with radiological evidence to understand the mechanisms of action of erector spinae plane block to relieve pain in hip surgery. Effect of local anesthetic on the lumbar plexus is one of the plausible pathways in L-ESPB for its analgesic mechanism of action. Abbreviations @: At the rate of; CT: Computed tomography; ESM: Erector spinae muscle; ESPB: Erector spinae plane block; IV: Intravenous; L-ESPB: Lumbar erector spinae plane block; MRI: Magnetic resonance imaging; NRS: Numeric rating sore; OOP: Out of the plane; TP: Transverse process
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