Psoas Compartment Block Research Articles

Physiological variables for the objective detection of nerve block failure in dogs

ObjectiveTo identify physiological variables for objectively detecting nociception indicative of intraoperative peripheral nerve block failure. Study designA double-blinded randomized clinical study. AnimalsA sample of 14 male (40.8 ± 12 kg; mean ± standard deviation) and 16 female (34.3 ± 11.4 kg) client-owned dogs. MethodsDogs were randomly assigned to one of three groups for psoas compartment and proximal sciatic nerve blocks (0.2 mL kg–1 per site): guided bupivacaine (GBB), or saline (GSB) block or a blind bupivacaine block (BBB). Guided blocks were performed using an ultrasound-peripheral nerve locator combination. Premedication consisted of medetomidine 0.01 mg kg–1 and morphine 0.3 mg kg–1. General anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Receiver operator characteristic curve analysis was used to compare actual values and change in values of physiological variables between GSB and GBB. The Youden index and associated criterion for each physiological variable were used to determine an objective measure for nociception. Fisher’s exact t test, McNemar’s test and Cohen’s kappa statistical analysis were used to determine association, differences and inter-score reliability between the objective and subjective scoring for BBB. ResultsCardiovascular variables had good discriminating ability to identify a nociceptive response (p < 0.01). The Youden indices for mean (MAP) and diastolic (DAP) arterial pressure were most reliable in detecting nociception. The highest sensitivity was that of ΔMAP (100%) with good agreement between the subjective and objective scores of Δheart rate or systolic arterial pressure (SAP). The use of ΔMAP, ΔSAP, ΔDAP had the best ability in indicating peripheral nerve block failure (p < 0.001). Conclusions and clinical relevanceBlood pressure values can detect a response to surgical stimulus in adequately anaesthetized dogs. The use of ΔMAP, ΔSAP or ΔDAP may be considered as objective measures to detect nerve block failure.

Is the psoas compartment block effective in eliminating pain in children after hip surgery?

BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently.&#x0D; AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control.&#x0D; MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale.&#x0D; RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated.&#x0D; CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.

Comparison of continuous transmuscular quadratus lumborum block and continuous psoas compartment block for posterior total hip arthroplasty: A randomised controlled trial.

Analgesia for hip surgery involves cutaneous anaesthesia at the site of the skin incision and the anterior hip capsule. This study aimed to compare continuous ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) with psoas compartment block (PCB) for analgesia in patients undergoing total hip arthroplasty (THA) under general anaesthesia (GA). This randomised, observer-blinded trial included 18-70-year-old American Society of Anesthesiologists physical status I-III patients undergoing THA under GA with either US-guided continuous TQLB or PCB. Primary objectives included a visual analogue scale (VAS; 0-100 mm) at rest and mobilisation at 6 h postoperatively (analysed by intention to treat and per protocol) using a non-inferiority margin of 20 mm. Secondary objectives included VAS at other time points, 24-h fentanyl consumption (analysed using the Wilcoxon rank-sum test), sensory dermatomes anaesthetised, motor weakness 30 min after block, and haemodynamic response to skin incision (analysed using the Chi-squared or Fisher's exact test). A P value less than 0.05 was considered statistically significant. VAS (0-100 mm) score at 6 h on rest was 25.34 ± 14.25 and 27.3 ± 9.6, mean difference (MD) was 1.9 [-3.3, 7.1] and at movement was 35.1 ± 23.0 and 38.6 ± 17.0, MD was 3.5 [-5.2, 12.2], in the PCB (n = 29) and QLB (n = 30) groups, respectively (i.e. less than the non-inferiority margin). However, VAS (rest) at 1, 12, and 24 h postoperatively and median (IQR) 24-h fentanyl consumption was significantly higher in the QLB group (1212.5 [300-2345] μg] when compared to the PCB group (635 [100-1645] μg; P = 0.0004). Though statistically, continuous QLB was non-inferior to continuous PCB for pain at rest and mobilisation at 6-hours postoperatively, a higher 24-hour perioperative fentanyl consumption and VAS show that QLB was clinically inferior to PCB.

Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.&#x0D; AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.&#x0D; MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.&#x0D; RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.&#x0D; CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

Total Spinal after Posterior Lumber Plexus Block, Case Report

Patients can undergo lower extremity surgery by using the lumbar plexus block (LPB) technique. However, compared with central block, LPB problems were complex. For lower limb procedures, psoas compartment block is a suitable regional anaesthesia approach in place of central neuraxial blockade. As a peripheral nerve block, it is considered less dangerous than a central neuraxial block. However, it might result in some severe issues. Here, we describe a rare side effect of total spinal anaesthesia following psoas compartment block guided by a peripheral nerve stimulator.

Combination of Femoral and Parasacral Sciatic Nerve Block as Multimodal Pain Management in Post Hemiarthroplasty Surgery Patient

Background: The prevalence of femoral neck fractures is high in geriatric patients with a high mortality rate. Many geriatric patients have comorbidities and find it difficult to tolerate general or neuraxial anesthesia during hip hemiarthroplasty. A more safe technique in lower extremities using peripheral nerve blocks is preferred. The combination of sciatic nerve blocks and psoas compartments can supply adequate anesthesia for hip surgery thus reducing mortality. Femoral nerve blocks decrease the incidence of complications than psoas compartment blocks. Case: A 88-year-old female patient, 70 kg, with distal femoral subtrochanteric fracture accompanied by dislocation, hypertension emergency, hyperplasia heart disease (HHD), and heart failure stage B Fc II were undergoing hemiarthroplasty with regional anesthesia sciatic nerve block and femoral block. After surgery, a block was performed using regional anesthesia sub-arachnoid block bupivacaine 0,5% 7mg + fentanyl 25 µg + Morphin 0,1 µg, post-operative pain with ultrasound, the patient received 0.375% naropin and 50 mg trilac total volume 20 cm3. Then femoral block was done with 0.375% and 50 mg trilac total volume 20 cm3. Patients were observed for pain scale during hospitalization, time of mobilization, and length of stay. Post-operative hemodynamic was stable, the pain scale using VAS assessment was 0-1 during hospitalization without additional opioid analgesia, active mobilization began on the 2nd day, and the length of stay was 3 days. Conclusion: The combination of a femoral and sciatic nerve block to the proximal part of the skin incision can supply adequate pain compliance for hip hemiarthroplasty.

Combined psoas compartment block and sciatic nerve block versus unilateral subarachnoid block as a sole anaesthetic technique for lower limb orthopaedic surgery – A prospective randomised controlled study

: Nerve block as a part on regional anaesthesia extends analgesia time and gives better haemodynamic stability, so comparison of nerve block like psoas compartment block and sciatic nerve block with spinal anaesthesia is our main aim of study. Total 96 patients of tibial surgeries with any gender of ASA grade I, II and III were assigned and randomly divided into two groups:- group P- psoas compartment block plus sciatic nerve block and group S-unilateral subarachnoid block. Parameters compared were onset, peak effect and duration of sensory and motor blockage, haemodynamic parameters, postoperative duration of analgesia and requirement of rescue analgesics post-operatively. Onset of motor and sensory block were faster in group S than group P. There was no significant difference in haemodynamic parameters in both the group. Duration of analgesia in group P was 16.79 ±2.3 hours as compared to group S was 5.57 ±0.49 hours, which was highly significant. Number of rescue analgesic required was significantly less in group P(1.10 ± 0.30) as compared to group S (3.04 ± 0.20) without significant complications in both the groups.Combined psoas compartment block with sciatic nerve block provides prolonged duration of analgesia over subarachnoid block and less numbers of rescue analgesics required postoperatively with good haemodynamic stability.

Surgeon-Performed Intraoperative Peripheral Nerve Blocks and Periarticular Infiltration During Total Hip and Knee Arthroplasty

Surgeon-performed intraoperative peripheral nerve blocks may improve operating room efficiency and reduce hospital resource utilization and, ultimately, costs. Additionally, these blocks can be safely performed intraoperatively by most orthopaedic surgeons, while only specifically trained physicians are able to perform ultrasound-guided peripheral nerve blocks. IPACK (infiltration between the popliteal artery and capsule of the knee) blocks are at least noninferior to periarticular infiltration when combined with an adductor canal block for analgesia following total knee arthroplasty. Surgeon-performed intraoperative adductor canal blocks are technically feasible and offer reliable anesthesia comparable with ultrasound-guided blocks performed by anesthesiologists. While clinical studies have shown promising results, additional Level-I studies are required. A surgeon-performed intraoperative psoas compartment block has been described as a readily available and safe technique, although there is some concern for femoral nerve analgesia, and temporary sensory changes have been reported.

A comparison of 0.375% ropivacaine psoas compartment block and 2% prilocaine spinal anaesthesia in dogs undergoing tibial plateau levelling osteotomy

BackgroundIn dogs undergoing routine elective orthopaedic surgeries carried out as same-day surgeries regional anaesthetic techniques (RATs) should aim to produce analgesia but minimising the postoperative motor dysfunction. Our objective was to compare the perioperative analgesic effects and the time to motor recovery between spinal anaesthesia (SA) with hyperbaric solution of prilocaine 2% (mg = 4 x [0.3 × BW (kg) + 0.05 × SCL (cm)]) and morphine (0.03 mg/kg) and combined ultrasound (US) and electro stimulator-guided psoas compartment and ischiatic nerve block (PB) with ropivacaine 0.375% (0.45 mL/kg). Dogs undergoing tibial plateau levelling osteotomy (TPLO) were randomly assigned to receive either SA or PB. Procedural failure, perioperative rescue analgesia, motor block recovery and complications were recorded.ResultsProcedural failure rate (PFR) was 19% (7 out of 36) for SA and 9% (3 out of 32) for PB (p = 0.31). Intraoperative rescue analgesia was administered to 6/29 (21%) SA group dogs and in 15/29 (52%) PB group dogs, respectively (p = 0.03). At 3 h after RAT, percentage of dogs with complete block recovery was 25/29 (86%) and 25/29 (86%) in group SA and PB, respectively (p = 1). Two cases of pruritus and one case of urinary retention were recorded in the SA group. Residual ischiatic nerve block was noted at 12 h after RAT in 2/15 (13%) of dogs in group PB; it completely resolved 24 h after RAT.ConclusionsSA with prilocaine 2% and PB with ropivacaine 0.37% were found suitable for dogs undergoing same-day TPLO surgery. Pruritus and urinary retention in SA and residual block in both groups might occasionally delay the time of discharge.

Ultrasound-Guided Comparison of Psoas Compartment Block and Supra-Inguinal Fascia Iliaca Compartment Block for Pain Management in Pediatric Developmental Dysplasia of Hip Surgeries.

BackgroundThe aim of this study was to compare psoas compartment block (PCB) and supra-inguinal fascia iliaca compartment block (SFIB) in terms of pain management and the need for additional systemic analgesia in the perioperative phase of developmental dysplasia of the hip (DDH).Materials and MethodsSixty pediatric patients were randomized into the PCB group and the SFIB group. The Numeric Rating Scale (NRS) pain scores were used to assess postoperative pain during the initial 24 h after extubation. Sufentanil consumption, patient-controlled analgesia (PCA) demands, and complications were also recorded.ResultsThe NRS pain scores were significantly lower in the PCB group than in the SFIB group at 0, 4, 8, 12, and 24 h after extubation (all P < 0.01). Postoperatively, 13.8% of patients in the PCB cohort received additional administration of sufentanil, in contrast to 63.3% of the SFIB cohort (P < 0.01). In the PCB group, 0 (0-0) mcg/kg sufentanil was administered, while in the SFIB group 0.1 (0-0.2) mcg/kg (P < 0.01). In addition, the PCB group had fewer PCA demands than the SFIB group within the initial 24 h (P < 0.01). It took less operating time to achieve SFIB as compared to PCB (P < 0.01). No adverse events related to two techniques were recorded.ConclusionsPCB provided a better perioperative pain management in pediatric patients with the DDH surgeries compared to SFIB. It also reduced the need for supplementary systemic analgesia.

Analgesic efficacy of posterior and anterior psoas compartment block: Lumbar plexus versus three -in-one nerve block after lower limb orthopedic surgery under spinal anesthesia: A prospective cohort study

IntroductionPostoperative pain is the most common complaint in patients who underwent orthopedic surgery. Regarding with the severity of pain, orthopedic patients suffered more than non-orthopedic patients in the immediate post-operative period. Therefore, pain management is crucial for better patient outcome. Lumbar plexus (LB) and three -in-one (3IN1) nerve blocks have been routinely practiced as pain management techniques in the study area but the analgesic efficacy was not studied yet. Thus, this study was aimed to compare the analgesic efficacy of the LBP versus 3IN1B as postoperative pain management after thigh orthopedic surgery under spinal anesthesia. MethodAn institutional-based prospective cohort study was conducted from October 10, 2020 to March 30, 2021 at the University comprehensive specialized hospital. Non-probability convenient sampling was used to select participants in both groups. The time to first analgesic request, severity of pain and total analgesia consumption within the first postoperative 24 h were measured. ResultThe mean and standard deviation to seek the first analgesia request time was 11. 55 ± 2. 82hr and 13. 35 ± 2. 58hr (p- 0.07) in patients who received LPB and 3IN1B respectively. Pain severity at rest and on movement was also comparable. The total tramadol consumption was 67. 65 ± 27. 20 mg and 70. 59 ± 37. 19 mg (p- 0.71), while total Diclofenac consumption was 63. 23 ± 45. 74 mg and 44. 88 ± 34. 72 mg (p-0.07) in LPB and 3IN1B groups respectively. ConclusionThe study showed that there was no significant difference in the time to first analgesia request, postoperative pain, both at rest and movement and total analgesic consumption, between the LPB and 3IN1B.

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

BackgroundProximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia.MethodsWe included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6–8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6–8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence.ResultsThere were no differences in the duration of ICU stay - gr.1 72 [70–75], gr.2 74 [72–76], gr.3 72 [70–75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170–184], gr.2170 [148–188], gr.3178 [144–200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0–5] mg versus 15 [10–20] and 20 [15–25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0–1] vs. 3 [2–4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7–9] vs. 6 [5–7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery – sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01–77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2–91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium.ConclusionPerioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed.Trial registrationClinicaltrials.gov: NCT04648332, first registration date 1/12/2020.

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

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.

Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia : Aprospective feasibility study.

Due to changing demographics geriatric patients with multiple comorbidities and proximal femoral fractures are an increasing patient population. In these patient groups, peripheral regional anesthesia could become increasingly more important besides established procedures, such as neuraxial or general anesthesia. The aim of this single center feasibility study was to evaluate acombined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture. We used aunilateral double injection three-step technique to block the sacral (parasacral block) and lumbar plexus (anterior quadratus lumborum and psoas compartment block, n = 78). The blockade was performed both under ultrasound guidance and simultaneous nerve stimulation and 20 ml ropivacaine 0.375% was injected at each of the 3 injection sites (total dose 225 mg). In 42% of cases the surgery was opioid-free (n = 33). In 5patients aconversion to general anesthesia (insertion of alaryngeal mask and pressure-controlled or pressure-supported ventilation) was necessary (6%). The overall success rate of combination anesthesia (peripheral nerve blocks with supplemental sedative (propofol 1-2 mg/kg*h) or analgesic (incremental doses of 5 µg sufentanil) medication) was 94%, regardless of fracture type and surgical treatment. The combined anesthetic technique presented in this study enables surgical treatment of proximal femoral fractures. The associated effort and requirement for expert knowledge in regional anesthesia indicates that this method should be considered especially in cases with high anesthetic risk, suitable sonoanatomy, and non-compromised coagulation.

Comparative study of psoas compartment block and sciatic nerve block with that of spinal block anesthesia for lower extremity surgeries

Aim and Objectives: Aim of the present study was to compare the efficacy of the block, hemodynamic effects, postoperative analgesia and side effects of combined psoas compartment sciatic nerve block with continuous spinal anaesthesia in adult patients undergoing lower extremity surgeries. Materials and Methods: Sixty patients of either sex, ASA grade I, II and III, age between 18-70 years, were randomly allocated into two groups. In group A, psoas compartment block was performed by posterior approach using 30cc of 0.25% bupivacaine and sciatic nerve block by classical posterior approach using the 20cc of 0.25% bupivacaine. In group B, continuous spinal anaesthesia was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 3cc (15 mg) of 0.5% heavy bupivacaine. We studied various parameters of block, hemodynamic effects, duration of postoperative analgesia and any complications. Results: Group B had earlier onset of sensory and motor block as compare to group A. The mean duration of sensory and motor block was significantly prolonged in group A than in group B. The efficacy of sensory blockade was comparable in both the groups while in group A 90% patients and in group B 97% of patients had complete motor blockade. The incidence of hypotension was more with group B as compared to group A. The duration of post-operative analgesia was longer in group A than in group B. No major complications were observed in both the groups. Conclusions: It was concluded that combined psoas compartment block and sciatic nerve block is a beneficial alternative to existing anaesthesia techniques for lower extremities surgeries. Keywords: Bupivacaine, Combined psoas compartment-sciatic nerve block, Continuous spinal anaesthesia, Lower extremity surgeries, Post-operative analgesia, Sensory and motor blockade.

Comparing approaches to sciatic nerve blocks in dogs during tibial plateau-levelling osteotomy

The aim of this study was to compare the postoperative analgesic requirements in dogs receiving a sciatic nerve block by either the lateral or transgluteal approach. The secondary aim was to determine if there was a difference in ease of performing the nerve block. Forty-two client-owned dogs were used in this study. Sciatic nerve block was performed by the transgluteal approach (group A), or the lateral approach (group B) combined with a psoas compartment block. All blocks were performed using a nerve stimulator and 0.1 ml/kg bupivacaine 0.5%, per block. The time taken to perform the sciatic nerve block, number of attempts, the current (mA), and intraoperative and postoperative opioid requirements were recorded. Overall, 52% of dogs required methadone intraoperatively, with no difference between groups (P=0.516). Postoperatively, 24% in group A and 12% in group B required methadone (P=0.314). There was no difference in the time taken to perform the sciatic nerve block, current or the number of attempts between groups. Both approaches to the sciatic nerve block conferred similar levels of analgesia and may be used as part of a multimodal analgesic protocol for dogs undergoing pelvic limb surgery.

Ultrasound guided psoas compartment block and sciatic nerve block for revision arthroplasty of the knee performed two times in a patient with ankylosing spondylitis

Anesthetic management including endotracheal intubation and neuroaxial blocks is challenging in patients with ankylosing spondylitis because of the stifness of vertebral joints. Peripheral blocks in these patients may be helpful although it is not common. A 56 year-old male patient with ankylosing spondylitis having the history of total knee arthroplasty and difficult airway management was operated for the contracted knee joint prosthesis. Anteromedialisation of tuberositas tibia was performed with combination of ultrasound guided psoas compartment block (PCB) and sciatic nevre block (SNB), and repeated forty days later because of the displacement of the osteotomy site. We conclude that PCB together with SNB may be performed for knee surgery in patients with severe ankylosing spondylitis.&#x0D; Bangladesh Journal of Medical Science Vol.19(4) 2020 p.772-774

Ultrasound-guided psoas compartment and sciatic nerve blocks for pain management of hind limb procedures in the alpaca (&lt;i&gt;Vicugna pacos&lt;/i&gt;)

Background:Loco-regional anesthetic techniques are considered important in the multimodal approach to analgesia in both human and veterinary medicine. No such techniques are described in the alpaca, bar the use of epidural. This is in part due to the lack of anatomical description for this species. While this limitation exists, the use of ultrasound guidance makes peripheral nerve blocks a viable possibility in the alpaca.Case description:A 12-month-old alpaca was referred for the treatment of a septic left tarso-crural joint. Due to a poor prognosis, amputation of the limb under general anesthesia was performed. Sciatic and psoas compartment blocks were attempted with the ultrasound-guided injection of ropivacaine prior to the start of the procedure. While the femoral nerve was possible to visualize, no obturator nerve was identified. A 5-year old alpaca was also referred for a left hind lateral claw removal, due to a squamous cell carcinoma. The sciatic nerve block was performed prior to the claw amputation under general anesthesia. No changes in heart and respiratory rate, or blood pressure suggestive of nociception, were observed in either of these cases. At the end of both the procedures, the patients experienced uneventful recoveries characterized by the ability to maintain the standing position, interest in food, and normal behavior.Conclusion:This report identifies the ease of performance and the challenges encountered using the ultrasound-guided psoas compartment and sciatic nerve blocks in the alpaca. It is our hope that this report encourages the use of ultrasound-guided loco-regional techniques in this species.

Comparative analysis of the effects of combined spinal epidural anesthesia versus psoas compartment and sciatic nerve block for partial hip prosthesis in the geriatric population

Aim: We aimed to compare combined spinal-epidural anesthesia (CSE) and combined psoas compartment & sciatic nerve block (PCSNB) peripheral nerve blocks, in terms of intraoperative and postoperative pain, hemodynamics and side effects in geriatric population who underwent partial hip prosthesis.Material and Methods: A total of 50 patients who underwent elective partial hip prosthesis and PCSNB or CSE were included. The age range was between 60-99 years and ASA scores were ≤ 3. Twenty-five patients underwent CSE anesthesia with 1 mL plain bupivacaine, while PCSNB and iliac crest blocks were employed in 25 patients. Perioperative anesthetic efficacy, blood pressures, pulse rates, saturation values, need for postoperative analgesia and side effects were compared. Results: At the end of the operation, the mean arterial pressure was lower in both groups compared to the baseline (initial) values and the decline in the CSE group was statistically significant. Hypotension was detected in 11 patients (44%) in the CSE group and 2 patients (8%) in the PCSNB group. Effective analgesia was provided in all patients in the CSE group, while 5 patients (20%) required additional analgesic medications through the epidural catheter in the follow-up. The first postoperative analgesic hour was remarkably longer in the PCSNB group (4.84 ± 2.54 hours vs. 1.64 ± 0.9 hours).Conclusion: Our data demonstrated that the combination of the psoas compartment, parasacral, sciatic and iliac crest blocks provides effective analgesia and maintains hemodynamic stability after hip prosthesis operations in elderly patients.

Comparison Between the Analgesic Efficacy of Erector Spinae Plane Block and Psoas Compartment Block in Hip Surgery

Comparison Between the Analgesic Efficacy of Erector Spinae Plane Block and Psoas Compartment Block in Hip Surgery