Psoas Compartment Block for Lower Limb Surgeries: A Comparative Study among The Four Lumbar Plexus Localizing Methods

Abstract

Background: Psoas compartment block (PCB) is a frequently used techniques providing anesthesia for proximal lower limb surgeries. There are many methods of localization of peripheral nerves for regional anesthesiaas loss of resistance (LOR), electric nerve stimulation (ENS), ultrasound-guided (US) and combined ultrasound-guided and electric nerve stimulation (US/ENS). Objective: To compare between these four techniques to find out the method of better outcome and least complications. Patients and Methods: This study was a prospective randomized trial, conducted at Anesthesia and Intensive Care Department, Zagazig University Hospitals during the period from January 2018 to January, 2020. 140 patients undergoing unilateral elective proximal lower limb surgeries were included. Patients were categorized randomly, according to the used method for lumbar plexus localization, into four equal groups (each 35 patients). All groups were compared regarding efficacy and safety. Results: The success rates of PCB in ENS, US and US/ENS groups were higher than that in LOR group with combined US/ENS group was the best group (97.14%). The onset of sensory and motor blocks in ENS, US and US/ENS groups were shorter than that in LOR group. Times to ask for the 1st postoperative analgesia in ENS, US and US/ENS groups were longer than those in LOR group with the consumed amount of morphine for pain relief during the 1st 24 hours postoperatively in ENS, US and US/ENS groups were lower than that in LOR group. Conclusion: Usage of combined ultrasound and electric nerve stimulation was better regarding the outcome and complications.