Posterior Lumbar Plexus Research Articles

Retracted: Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

[This retracts the article DOI: 10.1155/2022/8494796.].

Effects of posterior lumbar plexus block on anesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric comminuted fractures

ABSTRACT To study the effect of posterior lumbar plexus nerve block on anaesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures. The research subjects selected 48 patients with postmenopausal osteoporotic subtrochanteric comminuted fractures who were hospitalized between January 2020 and January 2022, and were allocated to clusters according to the random number TBL approach. The controlling cluster (24 situations) underwent dura mater Under external anesthesia, the test cluster (24 situations) underwent posterior lumbar plexus block, and the block effect, anesthesia effect, sedation effect, hemodynamics, vital signs and reactions of adverse nature were contrasted involving the two clusters. In comparison to the control group, the test group had a longer duration of anesthesia and motor block, higher oxygenation indices but lower ITBVI, GEDVI, and ScrO2 values, lower MAP levels, and lower BIS contraction values at 5, 15, and 30 minutes following anesthesia (P < 0.05). The test group had shorter induction time and block onset time compared to the control group (P < 0.05), and a lower incidence of adverse reactions (16.67% vs. 29.17% in the control group), but the variation was not noTBL (P < 0.05). Posterior lumbar plexus nerve block in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures has a better sedative effect, shortens the induction time of anaesthesia and the onset of block, promotes sTBL haemodynamic indexes and has fewer adverse effects to ensure safety.

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. To investigate the efficacy of posterior lumbar plexus block anesthesia during surgery for elderly patients with lower extremity fractures. In total, patients were divided into study and control groups. Anesthesia was administered by posterior lumbar plexus nerve block in the study group and epidural anesthesia in the control group. Hemodynamic parameters, anesthesia condition, pain level (VAS), and adverse effects were measured in both groups before anesthesia (T0), at anesthesia induction (T1), 30 min into the operation (T2), and at the end of the operation (T3). At T0, there were no significant differences in MAP and HR between the study and control groups. However, MAP and HR in the study group were significantly lower than those in the control group at T1, T2, and T3. The BIS value of the study group at each time point after anesthesia was significantly lower than that of the control group. The onset and induction time of anesthesia in the study group were also significantly shorter than those in the control group. Preoperative VAS scores did not differ between the study and control groups. However, the VAS scores of the study group at each time point were significantly lower than those of the control group. There was no significant difference in the incidence of adverse reactions between the two groups. Our results suggest that anesthesia with posterior lumbar plexus block surgery for lower extremity fractures in elderly patients can maintain hemodynamic stability and reduce block onset time, anesthesia induction time, and pain.

An uncommon cause of nerve stimulator’s malfunction during a dual guidance lumbar plexus block: A technical brief report and an algorithm for prevention of complications

Posterior Lumbar plexus block (PLPB) combined with an ipsilateral sacral plexus block is a valuable anaesthetic technique in patients undergoing hip fracture surgery. PLPB is performed through the acoustic window of the lumbar ultrasound trident and the position of the needle tip, before injection of LA, was confirmed by observing quadriceps femoris muscle contraction to peripheral nerve stimulation (i.e., dual guidance). We report an uncommon cause of nerve stimulator malfunction that might impair block performance and promote complications. We add an algorithm to limit the risk of complications.

Ultrasound-guided anterior iliopsoas muscle space block versus posterior lumbar plexus block in hip surgery in the elderly: A randomised controlled trial.

Ultrasound-guided posterior lumbar plexus block is widely used for hip fracture surgery but it requires a change of position, which may be painful. Our primary objective was to describe a new technique, the anterior iliopsoas muscle space block, which can be performed in the supine position, and to test the hypothesis that its analgesia for hip surgery was similar to that of the traditional posterior lumbar plexus block. Randomised, double-blind study. Shanghai 6th People's Hospital, China, from February to August 2019. Forty-eight patients scheduled for unilateral hip fracture surgery were included in the study. The exclusion criteria were infection at the puncture site, history of hip surgery, pre-existing neurological deficits of the lower extremity, contraindications for regional anaesthesia, allergy to local anaesthetics, coagulopathy, abuse of medicine or alcohol, or daily consumption of analgesics. Patients were randomised to receive a lateral sacral plexus block with either an anterior iliopsoas muscle space block or a posterior lumbar plexus block, using 0.33% ropivacaine (30 ml each). The main outcome was verbal numerical scale (VNS) pain intensity 1 h after surgery in the postanesthesia care unit, and the secondary outcome was the dose of intra-operative fentanyl. The differences in VNS scores and fentanyl use between the groups were analysed. Based on previous work, we considered a difference (confidence interval [CI]) of 1.6 on the VNS to be significant. The median [IQR] pain scores in postanesthesia care unit were similar in the anterior 0 [0 to 3] and posterior groups 1.5 [0 to 3]. The median scores for intra-operative fentanyl use were similar in the anterior 20 [10 to 42.5] μg and posterior groups 15 [0 to 50] μg (P = 0.34). The difference in the median pain score at-rest was NS: anterior group 0.5 [0 to 5], posterior group 0 [0 to 2], median difference -0.5 (95% CI -2 to 0). The median post to preblock difference in VNS was higher in the anterior -0.5 [-2 to 0] than in the posterior group 0 [-1.25 to 0], median difference 0.5 (95% CI 0 to 1). The median block onset time was longer in the anterior 11 [6 to 14.25] min than in the posterior group 6 [4.75 to 8] min (P = 0.002), median difference -5 (95% CI -7 to -1). The anterior iliopsoas muscle space block had the same effect as the posterior lumbar plexus block on peri-operative analgesia for hip surgery, but with a longer onset time. Therefore, anterior iliopsoas muscle space block can be recommended as a routine technique for hip and lower limb procedures. http://www.chictr.org.cn identifier: ChiCTR1900021214.

Quadratus lumborum block type 3 versus lumbar plexus block in hip replacement surgery: a randomized, prospective, non-inferiority study

IntroductionThe posterior lumbar plexus block (LPB) has been used for decades to provide acute pain management after hip surgery. Unfamiliarity with the technique and its perceived difficulty, potential risks, and...

Dexmedetomidine as an adjuvant to bupivacaine on combined posterior lumbar plexus and sciatic nerve blocks, is it effective?

ABSTRACTBackground: Many drugs were added bupivacaine to extend the total time of analgesia in the postoperative period. Dexmedetomidine was a successful additive in neuraxial block. It provides stable hemodynamics and better and prolonged analgesia after surgery. By this present work, we aim to assess the role of added dexmedetomidine to bupivacaine during combined sciatic and posterior lumbar plexus blocks during femur surgery regarding period of sensory and motor blocks, efficacy of its analgesic effect and incidence of adverse effects.Methods: Our trial was done on 80 patients undergoing femur surgeries. They were all randomly chosen into two groups which have undergone combined sciatic nerve and posterior lumbar plexus blocks as solo anesthetic technique by peripheral nerve blocks. Group I: patients received bupivacaine 0.5% with no additives. Group II: patients received dexmedetomidine 100 µg with bupivacaine 0.5%.Results: Adding dexmedetomidine prolongs total duration of motor and sensory block significantly by more than twofold (p = 0.001) as well as it took shorter time to achieve loss of pinprick sensation and also a shorter time was required to reach modified Bromage scale grade IV. Patients in Group 1 requested analgesia earlier after surgery, as well as they had significantly higher morphine consumption postoperatively compared to those in Group II (p = 0.001).Conclusion: Adding of dexmedetomidine to the local anesthetic lessen the time till the beginning of the block and lengthen its total duration. It also prolongs analgesia postoperatively and has few side effects.

Efficacy of "over iliac crest method" for ultrasound-guided posterior lumbar plexus block: a comparison with manual palpation and sagittal positioning

Objective To evaluate the efficacy of over iliac crest for ultrasound-guided posterior lumbar plexus block by comparing with manual palpation and sagittal positioning. Methods A total of 75 patients, aged 25-64 yr, weighing 42-90 kg, with body mass index of 17-32 kg/cm2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective lower extremity surgery under ultrasound-guided posterior lumbar plexus block combined with parasacral sciatic nerve block, were divided into 3 groups (n=25 each) using a random number table method: manual palpation group (group M), sagittal positioning group (group S) and over iliac crest group (group O). Patients received ultrasound-guided posterior lumbar plexus block with in-plane technique using the corresponding positioning method in M, S and O groups.Successful blockade of each level was recorded at 30 min after injection.Time to determine the lumbar intervertebral space, puncture time for lumbar plexus block, the requirement for adjuvant drugs and block efficacy were recorded.The development of complications related to puncture and nerve block was also recorded. Results Compared with group M, the success rates of blockade at levels L1 and L2 were significantly increased, the success rates of blockade at levels L4 and L5 were decreased (P 0.05), the time to determine the lumbar intervertebral space was prolonged, and the requirement for adjuvant drugs was decreased during surgery in O and S groups, and the efficacy of block was significantly enhanced in group O (P 0.05). There was no significant difference in the puncture time for lumbar plexus block between the three groups (P>0.05). Complications related to puncture and nerve block were not found in three groups. Conclusion Over iliac crest provides higher success rate and better efficacy than manual palpation and sagittal positioning when used for lumbar plexus block. Key words: Lumbosacral plexus; Nerve block; Ilium

Continuous Posterior Lumbar Plexus Nerve Block Versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Total Hip Arthroplasty: A Three-Arm Randomized Clinical Trial.

Debate surrounds the issue of whether peripheral nerve blockade or periarticular infiltration (PAI) should be employed within a contemporary, comprehensive multimodal analgesia pathway for total hip arthroplasty. We hypothesized that patients treated with a continuous posterior lumbar plexus block (PNB) would report less pain and consume less opioid medication than those treated with PAI. This investigator-initiated, independently funded, 3-arm randomized clinical trial (RCT) performed at a single high-volume institution compared postoperative analgesia interventions for elective, unilateral primary total hip arthroplasty: (1) PNB; (2) PAI with ropivacaine, ketorolac, and epinephrine (PAI-R); and (3) PAI with liposomal bupivacaine, ketorolac, and epinephrine (PAI-L) using computerized randomization. The primary outcome was maximum pain during the morning (06:00 to 12:00) of the first postoperative day (POD) on an ascending numeric rating scale (NRS) from 0 to 10. Pairwise treatment comparisons were performed using the rank-sum test, with a p value of <0.017 indicating significance (Bonferroni adjusted). A sample size of 150 provided 80% power to detect a difference of 2.0 NRS units. We included 159 patients (51, 54, and 54 patients in the PNB, PAI-R, and PAI-L groups, respectively). No significant differences were found with respect to the primary end point on the morning of the first POD (median, 3.0, 4.0, and 3.0, respectively; p > 0.033 for all). Opioid consumption was low and did not differ across groups at any intervals. Median maximum pain on POD 1 was 5.0, 5.5, and 4.0, respectively, and was lower for the PAI-L group than for the PAI-R group (p = 0.006). On POD 2, maximum pain (median, 3.5, 5.0, and 3.5, respectively) was lower for the PNB group (p = 0.014) and PAI-L group (p = 0.016) compared with the PAI-R group. The PAI-L group was not significantly different from the PNB group with respect to any outcomes: postoperative opioid use including rescue intravenous opioid medication, length of stay, and hospital adverse events, and 3-month follow-up data including any complication. In this RCT, we found a modest improvement with respect to analgesia in patients receiving PNB compared with those receiving PAI-R, but not compared with those who had PAI-L. Secondary analyses suggested that PNB or PAI-L provides superior postoperative analgesia compared with PAI-R. For primary total hip arthroplasty, a multimodal analgesic regimen including PNB or PAI-L provides opioid-limiting analgesia. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the epidural block and posterior lumbar plexus block for intra- and postoperative analgesia in total hip arthroplasty

Objectives. Evaluation of management of intra- and postoperative analgesia in patients who benefited from total hip arthroplasty in the surgical treatment of coxarthrosis. The achievement of this goal could reside in the comparison of two distinct methods of anaesthesiology: epidural analgesia and continuous lumbar plexus block. Materials and methods. The current prospective study, conducted between January 2014 and January 2016, targets a total of 48 patients who underwent total hip replacement surgery. There was a split in two groups: 23 patients benefited from epidural analgesia and 25 patients were selected for lumbar plexus block, depending on the procedure chosen by the anaesthetist. Both groups received the same concentration of initial dose of 0.75% Ropivacaine, the first group initially receiving 3 ml (test dose), then another 6 ml, and the second initially 5 ml (test dose), then 15 ml. Through catheters were injected continuously 8 ml / h of 0.2% Ropivacaine for the first group and 10 ml / h of Ropivacaine 0.375%, these doses being adjusted to Pain Visits, performed twice a day. The purpose of these visits was to monitor both the evolution of implanted catheters and the completion of mandatory protocols (these protocols monitor sensitivity and motor activity of limbs, initiation of mobilization, opioid supplementation to ongoing therapy, and patients'satisfaction with therapy, at catheter removal). Results. Patients in the first group had the highest satisfaction rate of 30.4%, compared to patients in the second group, who scored 52% for the 15 (maximum) level of satisfaction. In the first group of patients, 52.2% did not require additional opioids for ongoing therapy (in postoperative units or in the department), while for patients in the second group the percentage was 60%. In terms of complications, the differences are notable and have an important statistical value: the first category of patients, 52.17% (n = 12), the second category, 12% (n = 3). Day zero (surgery day) is not marked by significant differences between the two categories of people in treatment, in terms of pain intensity. At rest, 78.2% of the first category patients and 84% of the second category patients had a NRS of less than or equal to 4, while in the state of mobilization, the percentages were 78.2% and 80% respectively. The initiation of mobilization is an important parameter, which also presents variations between the two groups of patients: 73.9% of them initiated the mobilization on the first postoperative day (group I) and 88% initiated the mobilization on the first postoperative day (group II). Conclusions. Both methods of regional anaesthesia determine optimal analgesia for patients operated by THA with an onset of ideal mobilization from the first postoperative day, but the continuous lumbar plexus block produces better mobility in the second postoperative day and has a lower complications rate.

Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty: A Retrospective Cohort Study.

While benefits of regional anesthesia in total hip arthroplasty (THA) are well documented, data describing the incidence of complications related to the use of posterior lumbar plexus blockade for THA remain limited. Our primary aim was to evaluate the incidence of infectious, bleeding, and neurological complications related specifically to the use of continuous posterior lumbar plexus block for elective THA. We reviewed the electronic medical records of all adult patients who underwent elective THA with continuous posterior lumbar plexus blockade between December 1, 2004, and April 30, 2015, using the Mayo Clinic Total Joint Registry. All complications were verified via manual chart review by 2 reviewers. Patient demographics, type of surgery, and complications were analyzed. A total of 9649 patients who underwent 11,395 THA procedures met the inclusion criteria. There were 8686 (76.2%) primary and 2709 (23.8%) revision THAs. There were no block-related infections (0.00%; 95% confidence interval [CI], 0.00%-0.03%) and only 1 block-related hematoma (0.01%; 95% CI, 0.00%-0.05%) in a patient with multiple risk factors for bleeding. There were 60 (0.53%; 95% CI, 0.40%-0.68%) perioperative nerve injuries. Forty-three were in the sciatic distribution (71.67%; incidence, 0.38%). Although there were no documented overt iatrogenic nerve injuries, the posterior lumbar plexus blockade could not be excluded as the potential cause in 9 cases (incidence, 0.08%) based on clinical distribution or electromyographic findings. In our large, single-center cohort study, we report no catheter-related infections, whereas catheter-related hemorrhagic and neurological complications also appear to be rare.

Ambulatory Continuous Posterior Lumbar Plexus Blocks Following Hip Arthroscopy

Ambulatory Continuous Posterior Lumbar Plexus Blocks Following Hip Arthroscopy

Ambulatory continuous posterior lumbar plexus blocks following hip arthroscopy: a review of 213 cases

Study ObjectiveTo evaluate complications associated with ambulatory continuous lumbar plexus blocks. DesignRetrospective review of all patients who received a continuous lumbar plexus block for analgesia following arthroscopic hip surgery from January 2004 to July 2009. SettingAcademic medical center. MeasurementsData from 213 patients who were discharged home with a continuous lumbar plexus block following hip arthroscopy were studied. Side effects and complications, including impaired ambulation, systemic local anesthetic toxicity, abnormal local anesthetic spread, and neurologic injury, were recorded. Main ResultsOf the 281 patients who received a continuous lumbar plexus block following hip arthroscopy, 213 were discharged home with the continuous lumbar plexus block. Significant complications occurred in 3.8% of patients (8/213). Twenty of 213 patients (9.4%) reported prolonged sensory or motor deficits after the continuous lumbar plexus block was removed. Most of these deficits were minor and resolved spontaneously, but 4 patients (1.9%) experienced persistent neurologic symptoms. One patient had a fall, one patient was readmitted for possible bilateral spread from the continuous lumbar plexus block, and two patients experienced symptoms of local anesthetic systemic toxicity (LAST). ConclusionsWhile complications associated with hip arthroscopy with ambulatory continuous lumbar plexus blocks do occur, significant complications are uncommon. Most complications are managed easily on an outpatient basis. However, nearly 1% of patients presented with symptoms concerning for LAST and were treated without any hemodynamic compromise.

Blocco continuo del plesso lombare con approccio posteriore sotto guida ecografica in pazienti sottoposti a chirurgia dell’anca: studio pilota

This pilot study describes an ultrasound-guided technique for lumbar plexus catheterization. We enrolled 10 patients undergoing posterior lumbar plexus catheterization under ultrasound guidance (5-2 MHz convex probe) at L2–L3 level for postoperative analgesia after primary, unilateral hip arthroplasty or hip fracture repair. Each perineural catheter was injected with contrast medium (CM) and verified with portable X-rays postoperatively. We verified postoperatively the level of analgesia with Numerical Rating Scores (NRS) for pain at rest and on movement, and we administered morphine 5 mg subcutaneously in patients with NRS >4. The number of patients requiring rescue analgesia was registered.

Posterior lumbar plexus perineural catheter insertion by ultrasound guidance alone

Posterior lumbar plexus perineural catheter insertion by ultrasound guidance alone

Continuous Femoral Versus Posterior Lumbar Plexus Nerve Blocks for Analgesia After Hip Arthroplasty

Hip arthroplasty frequently requires potent postoperative analgesia, often provided with an epidural or posterior lumbar plexus local anesthetic infusion. However, American Society of Regional Anesthesia guidelines now recommend against epidural and continuous posterior lumbar plexus blocks during administration of various perioperative anticoagulants often administered after hip arthroplasty. A continuous femoral nerve block is a possible analgesic alternative, but whether it provides comparable analgesia to a continuous posterior lumbar plexus block after hip arthroplasty remains unclear. We therefore tested the hypothesis that differing the catheter insertion site (femoral versus posterior lumbar plexus) after hip arthroplasty has no impact on postoperative analgesia. Preoperatively, subjects undergoing hip arthroplasty were randomly assigned to receive either a femoral or a posterior lumbar plexus stimulating catheter inserted 5 to 15 cm or 0 to 1 cm past the needle tip, respectively. Postoperatively, patients received perineural ropivacaine, 0.2% (basal 6 mL/hr, bolus 4 mL, 30-minute lockout) for at least 2 days. The primary end point was the average daily pain scores as measured with a numeric rating scale (0-10) recorded in the 24-hour period beginning at 07:30 the morning after surgery, excluding twice-daily physical therapy sessions. Secondary end points included pain during physical therapy, ambulatory distance, and supplemental analgesic requirements during the same 24-hour period, as well as satisfaction with analgesia during hospitalization. The mean (SD) pain scores for subjects receiving a femoral infusion (n = 25) were 3.6 (1.8) versus 3.5 (1.8) for patients receiving a posterior lumbar plexus infusion (n = 22), resulting in a group difference of 0.1 (95% confidence interval -0.9 to 1.2; P = 0.78). Because the confidence interval was within a prespecified -1.6 to 1.6 range, we conclude that the effect of the 2 analgesic techniques on postoperative pain was equivalent. Similarly, we detected no differences between the 2 treatments with respect to the secondary end points, with one exception: subjects with a femoral catheter ambulated a median (10th-90th percentiles) 2 (0-17) m the morning after surgery, in comparison with 11 (0-31) m for subjects with a posterior lumbar plexus catheter (data nonparametric; P = 0.02). After hip arthroplasty, a continuous femoral nerve block is an acceptable analgesic alternative to a continuous posterior lumbar plexus block when using a stimulating perineural catheter. However, early ambulatory ability suffers with a femoral infusion.

Lumbar plexus block as a method of postoperative analgesia after hip surgery

BackgroundPosterior lumbar plexus block provides unilateral blockade and great hemodynamic stability. In this trial, the efficacy of addition of clonidine to bupivacaine used in lumbar plexus block (LPB) was evaluated.Patients and methodsSixty ASA I or II adult patients undergoing hip surgery, receiving general anesthesia, were randomly allocated to three equal sized groups, according to the technique of postoperative analgesia. In group A patients extubated when they met the standard extubation criteria. In group B, a mixed solution of 15 mL bupivacaine 0.5% and 15 mL normal saline 0.9% was injected through lumbar plexus block technique before extubation. In group C, 2.5 μg/ml clonidine was added to bupivacaine. Postoperative pain, sedation, hemodynamics, analgesic consumption, local anesthetic side effects and serum cortisol level were compared.ResultsThere was a highly significant statistical difference between the three groups as regards the postoperative VAS scores (P < 0.001). In contrast to group A patients, VAS remained <50 mm till the 6th hour postoperatively in group B patients and till the 12th hour in group C with high significant difference in postoperative morphine consumption (P < 0.001). Hemodynamics and respiratory rate were in normal range 2 h postoperatively in the three groups. After the 6th hour postoperatively; SBP, DBP, HR and RR were significantly higher in group A patients in comparison to groups B and C (P < 0.05). In group C patients; SBP, DBP, HR and RR were in normal range for the first 12 h postoperatively. Blood cortisol level was higher then normal in group A patients since 2 h postoperatively (P, 0.05), while started to rise from the 6th hour in group B patients and the 12th hour in group C patients.ConclusionThe study showed that posterior lumbar plexus block was an effective postoperative analgesic technique in patients undergoing hip surgeries and that adding clonidine in a concentration of 2.5 μg/ml to bupivacaine 0.25% has resulted in decreasing the postoperative analgesic requirements.

Continuous Bilateral Posterior Lumbar Plexus Block with a Disposable Infusion Pump. Case Report

The number of bilateral total hip arthroplasties (THA) has been increasing every year. Postoperative analgesia by continuous perineural infusion of local anesthetic has been shown favorable results when compared to systemic analgesia. The use of elastomeric pumps has increased patient satisfaction when compared to electronic models. The objective of this report was to describe a case of continuous bilateral posterior lumbar plexus block with an elastomeric infusion pump in a patient submitted to bilateral hip arthroplasty. This is a 46 year-old female patient weighing 65 kg, 162 cm, with rheumatoid arthritis and hypertension, physical status ASA II, scheduled for bilateral THA in a single stage. She had been on corticosteroids for 13 years. Hemoglobin=10.1 g.dL⁻¹, hematocrit=32.7%. Routine monitoring. Spinal anesthesia with 15 mg of 0.5% isobaric bupivacaine. General anesthesia with propofol (PFS) and remifentanil, and intubation without neuromuscular blockers. Right THA and, at the end, lumbar plexus block with a stimulator and a set of 150 mm needle and injection of 20 mL of 0.2% bupivacaine and introduction of a catheter. Left THA and, at the end, the same procedure. Anesthetic dispersion and contrast were investigated. Elastomeric pump was installed with 0.1% bupivacaine (400 mL) at a rate of 14 mL.h⁻¹. The patient was transferred to the Intensive Care Unit (ICU). After 24 hour, a new pump was installed with the same solution. She did not receive any boluses for 50 hours. After removal of the catheter, pain was controlled with oral ketoprofen and dypirone. Continuous peripheral blockade with infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.

Combined posterior lumbar plexus&amp;ndash;sciatic nerve block versus combined femoral&amp;ndash;obturator&amp;ndash;sciatic nerve block for ACL reconstruction

BackgroundWe compared the efficacy of combined posterior lumbar plexus–sciatic nerve block with that of combined femoral–obturator–sciatic nerve block as anesthesia for anterior cruciate ligament reconstruction surgery, because both block combinations have been recommended for lower limb arthroscopic and reconstructive surgery.MethodsForty-eight patients undergoing elective unilateral anterior cruciate ligament reconstruction under local anesthesia were randomized to undergo either combined posterior lumbar plexus–sciatic nerve block (Group 1), or combined femoral–obturator–sciatic nerve block (Group 2). Blocks were performed using nerve stimulation and bupivacaine 0.5% mixed with lignocaine 2%. Systolic and diastolic blood pressure, heart rate, and pulse oximetry were recorded. Quality of anesthesia, motor and sensory block, time to first analgesic use, sedation, and need for general anesthesia were recorded, along with verbal postoperative pain scores, and side effects.ResultsNo patient in Group 1 and two patients in Group 2 needed general anesthesia. Complete sensory blockade was higher in Group 1 than in Group 2. However, complete motor blockade was similar in both groups. In Group 1, verbal pain scores were lower than in Group 2. Time to first analgesic was similar between the two groups. Total analgesic consumption was lower in Group 1. No significant differences were found for heart rate, pulse oximetry, or systolic and diastolic blood pressure between the groups, and no signs of toxicity were encountered.ConclusionCombined posterior lumbar plexus–sciatic nerve block provided more comfortable intraoperative anesthesia and better postoperative analgesia than combined femoral–obturator–sciatic nerve block for anterior cruciate ligament reconstruction surgery.

The psoas compartment block for hip surgery: the past, present, and future.

A posterior lumbar plexus block or psoas compartment block (PCB) is an effective locoregional anesthetic technique for analgesia and anesthesia of the entire lower extremity including the hip. Since the first description in the early seventies, this technique has been modified based on advanced knowledge of the anatomical localization of the lumbar plexus and the improvement of technical equipment. This paper provides an overview of the history, clinical efficacy, and risk profile of the PCB focused on hip surgery. Current status and future expectations are discussed.