The distribution of anesthetic in the case of psoas-compartment block according to the data of radiography

Abstract

Anesthesia in hip surgery faces many problems due to age and comorbidity, the necessity of reliable intra- and perioperative anesthesia, thromboprophylaxis. That is why spinal and epidural anesthesia are so popular. However, a lot of potential risks are associated with these types of anesthesia: bradycardia, arterial hypertension, respiratory depression, postpuncture headache, epidural hematoma or abscess and so on. Peripheral nerves block both single application and prolong (via catheter) that include lumbar plexus and sciatic nerve, have some advantages comparing with spinal and epidural anesthesia. Several approaches are proposed to block effectively lumbar plexus in psoas-compartment. The goal: to assess the spreading of local anesthetic after the blockade in psoas-compartment via Capdevila approach. Methods: prolong blockades of psoas-compartment via catheter in lumbar plexus was used as a component of intra- and postoperative analgesia in case of total hip replacement in 21 adult patient. 10 ml of 1 % Lidocaine and 10 ml of contrast agent (iohexol) were injected in catheter at the end of operative procedure. Then standard AP radiography was performed with following assessment of contrast agent spreading along the vertebral bodies. Results: spreading of contrast agent along spinal segments LIII and LIV were found in all (100 %) patients, LV — 7 (33 %), LII — 5 (24 %), and along all, including LI–SI , — 2 (10 %) only. Moreover, two radiographic patterns were distinguished: 8 (38 %) patients had equal distribution of contrast agent along spine, but in 13 (62 %) patients contrast agent was predominantly concentrated near LIII and LIV bodies. Conclusion: 20 ml of solution always envelope LIII and LIV spinal segments, other segments may require additional blockade.