Psoas Compartment Block Research Articles

Combined psoas compartment and sciatic nerve block for lower limb surgery: An alternative anesthetic option in high-risk geriatric patients

Reported is a case series of high risk geriatric patients with multiple co-morbidities presenting for lower limb orthopaedic surgeries. Combined psoas compartment and sciatic nerve block proved useful as an alternative anaesthetic technique to central neuraxial blockade and general anaesthesia. We recommend the use of these peripheral nerve blocks as the sole anaesthetic option for lower limb surgeries in the emerging phase of easy accessibility of peripheral nerve stimulator and ultrasound in the operation theatres.

Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study.

BackgroundOur aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery.MethodsSeventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 μgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved.ResultsThe PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5th, 10th and 20th minutes of surgery compared to the CSA group (P =0.038, P =0.029, P =0.012, P =0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012).ConclusionsCSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.

Management of unpredictable higher level of block following psoas compartment block (PCB)

Management of unpredictable higher level of block following psoas compartment block (PCB)

Ultrasound-guided psoas compartment block and general anesthesia for arthroscopic knee surgery: a case report

Anesthetizing the lumbar plexus at its origin facilitates a more "complete" psoas compartment block compared to peripheral approaches. It is usually performed using surface anatomical landmarks, and the site for local anesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. Ultrasound may provide guidance alone or together with the aid of nerve stimulation during nerve blocks. We present a 48-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, who refused spinal anesthesia, and underwent knee arthroscopy with ultrasound-guided psoas compartment block and general anesthesia. Following the standard monitoring and lateral decubitus positioning, the vertebral body, psoas, erector spinae, and quadratus lumborum muscles and hyperechoic nerve roots of the patient were visualized at the level of L4-5 with curvilinear ultrasound probe. The needle was inserted with ultrasound guidance, and correct tip position was confirmed with quadriceps contraction. Then, the mixture of 30 mL local anesthetic (10 mL 2% lidocaine and 20 ml 5% levobupivacaine) was injected at the estimated position of the lumbar plexus (junction of the posterior third and anterior two-thirds of the psoas muscle). He also received general anesthesia for the surgery. Anesthesia and surgical procedures were completed successfully without any additional anesthetic/analgesic requirement or complication. The postoperative period was pain-free both at rest and during mobilization for 24 hours. This case report shows that ultrasound-guided psoas compartment block is feasible and efficient for peri- and postoperative analgesia during knee arthroscopy.

Caudal Anesthesia through Drilling Hole on Sacral Hiatus: A Case Report

A 40 (forty) year old male patient with Ankylosing Spondylitis was admitted for total replacement of left hip joint. Fusion of the axial skeleton, immobility of cervical spines and restricted movement of temporo- mandibular joint lead to anticipate difficulty in intubation and failure of central neuraxial blockade for total hip replacement. Above factors also compelled to discard the attempts for spinal or epidural or general anesthesia (G.A.) in the conventional way. Last of all, it was decided to operate under caudal anesthesia. But it was difficult to administer caudal anesthesia through calcified sacral hiatus. After through discussion with surgeons, decision was taken to drill the calcified membrane over the sacral hiatus. Through the drilling hole, nerve stimulator needle was introduced and 30 ml of local anesthetic was injected in sacral epidural space after electing dorsiflexion moment of great toe. Satisfied anesthesia developed within 5 minutes. At last, an epidural catheter was inserted within sacral epidural space and kept it left in the sacral epidural space. Operation was completed smoothly without any disturbance from patient's side. No hemodynamic instability was noted. Keywords: axial skeleton, cervical spines, blind nasal intubation, awake fiber optic intubation, peripheral nerve block, psoas compartment, nerve stimulator I. Introduction Airway management is the essential and topmost important component of general anesthesia and major responsibility of anesthesiologist during and after operation. For maintaining an intact functional airway and also for ventilating the anaesthetized patient, several techniques are advocated. Among those, endotracheal intubation achieved top most priority in airway management and also in ventilating the patient either for short term or long term procedure. Awake nasal intubation or fiber optic intubation is useful at the time of failed intubation or anticipated difficult intubation or at the time of failure of maintaining airway integrity and restoration of functional airway patency with mask ventilation. Laryngeal mask airway or intubating laryngeal mask airway is also useful to establish an airway patency of the patient in above purposes and also to avoid the pulmonary aspiration and pressure damage of the eye. But in emergency, this device (L.M.A.) is very much important life saving procedure for patent airway management to ventilate the anaesthetized patient. Ankylosing Spondylitis is always problematic and challenging case to anesthesiologist to anaesthetize the patient for their surgeries. In advanced form of Ankylosing Spondylitis, involvement of axial skeleton provides impracticability of central neuraxial procedure. The involvement of temporo-mandibular joint and fusion of cervical spine make the condition worst for intubation and general anesthesia become impossible without awake nasal or fiberoptic intubation. But both are troublesome, injurious and painful procedure without acceptance of patient. The Psoas compartment block with sciatic nerve block may form an alternative option to anesthetize. But its' reliability for major operation is doubtful. The sacral spinal anesthesia 1 or sacral epidural anesthesia 2 through its foramen is anticipated to be impossible due to obliteration of dorsal foramen of sacrum. For the above causes, decision was taken to anesthetize the patient with caudal anesthesia through the drilling hole on the sacral hiatus.

Surgeon Delivered Psoas Compartment Block in Total Hip Arthroplasty

Total hip arthroplasty is associated with significant postoperative pain. A psoas compartment block is superior to other regional techniques in analgesia post THA. However, traditional methods of delivery are associated with serious complications. We present a technique of a surgeon delivered lumbar plexus block through injection at the portion of the iliopsoas seen intraoperatively. We randomised fifty-three consecutive patients into two groups. The group that received the block had an increased period prior to requesting supplementary analgesia and lower overall pain scores. There were no adverse effects. We have demonstrated the analgesic efficacy of Psoas Compartment Block performed during surgical access for total hip arthroplasty. This technique should be considered in the analgesic regimen for total hip arthroplasty.

The impact of continuous psoas compartment block on surgical stress response and postoperative pain after hip replacement surgery

General Hospital of Sremska Mitrovica, Dept of Anaesthesiology & Intensive Care, Sremska Mitrovica, Serbia

The sonoanatomy of psoas compartment block in pediatric patients

The sonoanatomy of psoas compartment block in pediatric patients

The analgesic efficacy of continuous fascia iliaca block vs. continuous psoas compartment block after hip surgery: A comparative study

BackgroundBoth psoas compartment block and fascia iliaca compartment block have been shown to be reliable blocks for postoperative pain relief for procedures involving the hip joint. This study evaluated the efficacy of continuous psoas compartment block with continuous fascia iliaca block for postoperative analgesia after hip surgery.MethodsIn randomized blinded study Forty, ASA I–III patients aged 30–75 years, with BMI less than 40, scheduled for hip surgery, were divided to one of two groups. Group P: continuous psoas compartment block (n = 18) and group F: continuous fascia iliaca block (n = 19). Standard general anesthesia was induced after finishing the block technique. After recovery 30 ml of 0.125% levobupivacaine was injected through the catheter to all patients. Postoperative 24 h meperidine consumption, patient satisfaction, visual analogue scale pain scores at (1, 6, 12, 18, and 24 h) postoperative, postoperative hemodynamics (HR and MAp), evidence of sensory and motor blockades, and incidence of adverse effects were recorded.ResultsThere was no significant difference between the two groups in 24 h postoperative meperidine requirements, postoperative VAS, patient satisfaction, postoperative hemodynamics, and distribution of sensory and motor block of (femoral, lateral femoral cutaneous, and obturator nerves). The epidural anesthesia occurred in two patients in psoas group (11%).ConclusionBoth continuous fascia iliaca block and continuous psoas compartment block were comparable in providing safe and effective analgesia after hip surgery.

Psoas Compartment Blockade in a Laterally Herniated Disc Compressing the Psoas Muscle -A Case Report-

A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.

Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) generates severe postoperative pain in 60% of patients and moderate pain in 30% of patients. Because inadequate postoperative pain control can hinder early physiotherapy and rehabilitation, it is the most influential factor dictating a good outcome. The purpose of this study was to evaluate the effectiveness of continuous psoas compartment block (PCB) in comparison to intravenous patient-controlled analgesia (IVPCA) in TKA patients.Methods40 TKA patients were randomly divided into 2 groups. Group IVPCA (n = 20) received intravenous patient controlled analgesia (IVPCA) for 48 hours. Group PCB (n = 20) received continuous PCB for 48 hours at the fourth intertransverse process of the lumbar using the C-arm. Pain scores, side effects, satisfaction, the length of hospital stay, rescue antiemetics, and analgesics were recorded.ResultsPain scores (VNRS 0-100) were higher in Group IVPCA than in Group PCB. Nausea and sedation occurred more frequently in Group IVPCA than in Group PCB. There were no differences between the groups in the length of the hospital stay, satisfaction scores, and the use of rescue antiemetics and analgesics.ConclusionsContinuous PCB seemed to be an appropriate and reliable technique for TKA patients, because it provided better analgesia and fewer side effects such as nausea and sedation when compared to IVPCA.

Psoas compartment block for intramedullary supracondylar nailing for fracture shaft femur in an 80-year-old patient with severe ischaemic heart disease, hypertension, COPD and anaemia

Psoas compartment block for intramedullary supracondylar nailing for fracture shaft femur in an 80-year-old patient with severe ischaemic heart disease, hypertension, COPD and anaemia

Psoas compartment block for operative reduction of hip fracture in a patient with increased intracranial pressure due to inoperable brain tumor

General and neuraxial anesthesia in patients with increased intracranial pressure (ICP) who present for non-neurosurgical surgery may cause life-threatening changes in ICP, with possible fatal outcome. Peripheral nerve blocks may be a safe alternative technique for limb surgery. The successful use of psoas compartment block for operative reduction of a hip fracture in a patient with increased ICP due to an inoperable brain tumor is presented.

A cadaveric study of injectate spread in the psoas compartment with a direct iliopsoas injection suggested for use during surgery

Total hip replacement produces significant postoperative pain. Psoas compartment block is the most effective block of the lumbar plexus in terms of pain relief and reduced blood loss. It is a proven regional technique for analgesia and anaesthesia during and after total hip replacement conferring a number of benefits to the patient. However, traditional techniques used to produce this block require increased theatre time and are associated with a number of serious complications. We present a surgeon-delivered technique for producing a lumbar plexus block using direct injection into the iliopsoas muscle when it is visible intraoperatively. This study shows a cadaveric model using methylene blue and radiopaque contrast produces injectate spread in a fashion which would produce a successful lumbar plexus block. This novel technique for lumbar plexus block affords the benefits of psoas compartment block with reduced complications and reduced administration time.

Psoas Compartment Block for Acute Postoperative Pain Management After Hip Surgery in Pediatrics

Lower-limb peripheral nerve blocks in pediatrics have gained much more popularity in the last few decades. Our purpose of this study was to compare the postoperative analgesic effects between psoas compartment block (PCB) and caudal block in small children undergoing open hip reduction/osteotomies. Forty American Society of Anesthesiologists physical status I-II children aged 1 to 6 years planned to undergo open hip reduction/osteotomies were administered general anesthesia and then randomly assigned to receive 1 of 2 regional anesthetics: caudal block (group C, n=20) or PCB (group P, n=20). Ropivacaine 0.25% with epinephrine (5 μg/mL) was used in both blocks. The primary outcome of the study was the total consumption of morphine in the first 24 postoperative hrs. Secondary outcomes included dose of intraoperative fentanyl, occurrence of intraoperative hypotension or bradycardia, postoperative pain scores, time to first morphine analgesia, and occurrence of postoperative vomiting or urine retention. The cumulative dose of morphine administered in the ward in the first postoperative 24 hrs and the time to first rescue morphine dose were higher in group C than in group P (P<0.001). There were no differences between the 2 groups regarding intraoperative and postoperative complications except for the incidence of urine retention, which was higher in group C than in group P (P=0.037). Use of single-shot PCB is superior to single-shot caudal block regarding length of postoperative analgesia and cumulative dose of morphine in small children undergoing open hip reduction/osteotomies.

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.

Peripheral Nerve Blockade

Peripheral Nerve Blockade

Hemodynamic Changes During a Combined Psoas Compartment–Sciatic Nerve Block for Elective Orthopedic Surgery

Hemodynamic variables can theoretically be influenced by a combined psoas compartment-sciatic nerve block (CPCSNB) owing to a relatively high systemic absorption of local anesthetics and extended vasodilatation in the anesthetized limb (hemisympatectomy). In this study we assessed and documented hemodynamic changes during CPCSNB for elective orthopedic surgery. Twenty consecutive patients scheduled for a total hip arthroplasty revision surgery were subjected to a CPCSNB with 150 mg bupivacaine (with epinephrine 1:200.000) 90 minutes before surgery (2 separate single-injection blocks: 30 mg bupivacaine for the sciatic nerve block and 120 mg bupivacaine for the psoas compartment block). Cardiac index, invasive arterial blood pressure, and heart rate were measured at baseline and 60 minutes after puncture using a minimally invasive cardiac output monitoring device (FloTrac/Vigileo™ system (Edwards Lifesciences, Irvine, CA)). Cardiac index did not change after a CPCSNB (preblock cardiac index 2.98 ± 0.54 l · min(-1) · m(-2) versus postblock cardiac index 2.99 ± 0.60 l · min(-1) · m(-2)). There was a significant reduction in mean arterial blood pressure (108 ± 16 mm|Hg vs. 99 ± 16 mm|Hg (P < 0.001)) and diastolic blood pressure (75 ± 9 mm|Hg vs. 68 ± 10 mm|Hg (P = 0.001)). Heart rate increased significantly (68 ± 9 beats · min(-1) vs. 73 ± 10 beats · min(-1) (P = 0.001)). CPCSNB did not affect cardiac index. Changes in arterial blood pressure and heart rate, although statistically significant, remained within an acceptable clinical range (<10% variation). CPCSNB does not appear to induce clinically significant hemodynamic changes in this group of patients.

Nerve guidance with versus without prepuncture ultrasound visualization for psoas compartment block and perineural catheter insertion: A randomized, prospective, blinded study

Lumbar plexus block may offer significant advantages in terms of postoperative analgesia, patient satisfaction, surgical outcome and patient rehabilitation. Ultrasound guidance has been used to describe psoas compartment block-related anatomy and to estimate transverse process depth before needle insertion and prediction of actual needle-to plexus intercept depth. The aim of this prospective randomized blinded study is to compare the Nerve-Stimulation Guidance with versus without the Pre-puncture Ultrasound Visualization in terms of onset time of the lumbar plexus sensory and motor block in patients undergoing total hip replacement. 46 patients undergoing total hip replacement were randomly allocated to receive posterior lumbar plexus block (LPB) using nerve stimulation guidance with (group US, n = 23) or without pre-puncture ultrasound imaging (group NS, n = 23). Onset time of sensory and motor blocks was recorded every 5 min for the first 30 min starting from the injection of the local anesthetic injection. Readiness for surgery was defined as complete numbness to pinprick test in the region supplied by the lumbar plexus and Bromage’s score = 3. Need for additional local anesthetic boluses or general anesthesia, intraoperative opioid consumption and first postoperative 24 h local anesthetic and rescue Analgesics consumption were also recorded. The time required for the execution of the block was 3 (2–15) min in Group US and 5 (2–20) min in Group NS ( p = 0.06). The mean time to readiness for surgery was 12 ± 5 in Group US and 19 ± 6 min in Group NS ( p = 0.04) . 3 Patients in Group US (13%) and 4 patients in Group NS (17%) ( p = 0.73) required general anesthesia due to failed block. Intraoperative opioid consumption was similar in the two groups. There were no differences in complications, postoperative local anesthetic and rescue analgesics consumption and pain scores. Nerve-Stimulation technique combined with Pre-puncture Ultrasound Visualization for continuous lumbar plexus blocks is comparable to Nerve-Stimulation technique in terms of percentage of block success, intraoperative opioid consumption and postoperative pain relief. Pre-puncture Ultrasound Visualization may reduce the time required for readiness to surgery.

Analgésie péridurale continue versus bloc continu du compartiment psoas pour l’analgésie postopératoire après chirurgie majeure du bassin ou du fémur chez l’enfant : étude prospective comparative randomisée

Background Intravenous opioids and/or continuous epidural block (CEB) are used for postoperative analgesia after hip and/or femoral shaft surgery but adverse effects limit their use in children. A continuous psoas compartment block (CPCB), effective technique in adults can be an alternative. In this randomized comparative study, we wanted to evaluate CEB and CPCB in children after major hip surgery in terms of adverse events, pain relief and ropivacaine plasma concentrations. Methods After ethical committee and parents’ approval, 40 children scheduled for hip surgery were included and randomly allocated to receive CPCB or CEB. After general anaesthesia induction, 0.5 mL/kg of 0.375% ropivacaine were injected via the epidural or lumbar plexus catheter. After surgery, 0.1 ml/kg per hour (group CPCB) or 0.2 ml/kg per hour (group CEB) of 0.2% ropivacaine was infused for 48 h. Post-operative pain was evaluated using VAS or CHIPPS scores values at h1, h6, h12, h18, h24, h36 and h48, as well as doses of first line (paracetamol 15 mg/kg/6 h) or second line rescue analgesia (0.2 mg/kg intravenous nalbuphine), if pain score remained high after 30 mm. niflumic acid was systematically used. Adverse events were noted as well as parents’ satisfaction at 48 h. Ropivacaine plasma concentrations were measured four times up to 48 h (h1, h6, h24 and h48) by high performance gas chromatography. Results Forty children 1 to 12 years old (CPCB = 20, CEB = 20) were included. The demographic data were equivalent in both groups. Postoperative analgesia was excellent for both continuous block techniques during the whole studied period. Doses of rescue analgesics were comparable in both groups at the end of the 48 h. Number of children who had at least one side effect is significantly higher in CEB group. Furthermore, the number of local anaesthetic premature stops was significantly more frequent in this group. Median values of ropivacaine plasma level in CEB group were significantly higher than CPCB group at h6 and h24. Ten parents in the CEB group and 15 in CPCB group were satisfied. Conclusion Continuous psoas compartment block is an effective technique of postoperative analgesia after major hip or femoral surgery in children. It equally manages postoperative pain with significantly less adverse event and decreased ropivacaine doses and plasma concentration than CEB.