Psoas Compartment Block Research Articles

Continuous psoas compartment block versus continuous femoral block in elderly patients with hip fractures

Antonopoulou, E.; Papaioannou, K.; Stertsou, E.; Karamoulas, B.; Itsiopoulos, I. Author Information

Prepuncture Ultrasound Imaging to Predict Transverse Process and Lumbar Plexus Depth for Psoas Compartment Block and Perineural Catheter Insertion

All widely used psoas compartment block/catheter techniques have a common limitation: external landmarks do not accurately predict lumbar plexus depth, leaving practitioners to "guess" at what depth to stop advancing the placement needle when neither transverse process nor lumbar plexus is intercepted. We assessed the accuracy of ultrasound in estimating transverse process depth before needle insertion and prediction of actual needle-to-plexus intercept depth for psoas compartment nerve blocks and perineural catheter insertion. Before needle insertion, ultrasound was used to estimate the depth of the transverse process lying directly anterior to the intercrestal line. If a transverse process was not directly anterior to the intercrestal line, then the process immediately caudad to the line was imaged. The ultrasound transducer remained in the parasagittal plane, perpendicular to the skin. After this measurement, the transducer was removed, an insulated needle connected to a nerve stimulator inserted in the parasagittal plane, and the depth of both the transverse process (if contacted) and lumbar plexus noted. A perineural catheter was subsequently inserted. Of 53 enrolled subjects, in 50 cases (94%), the transverse processes were identified by ultrasound at a median (interquartile; range) depth of 5.0 cm (4.5-5.5 cm; 3.5-7.5 cm). In 27 subjects (54%), a transverse process was positioned directly anterior to the intercrestal line, and in all of these subjects, the transverse process was intercepted with the block needle a median of 0.5 cm (0.0-1.0 cm; 0.0-1.0 cm) within the predicted depth. In all 50 subjects in whom the transverse processes were identified by ultrasound, the actual lumbar plexus depth measured with the needle was a median of 7.5 cm (7.0-8.5 cm; 5.0-9.5 cm), and the plexus depth was a median of 2.5 cm (2.0-3.0 cm; 0.2-4.0 cm) past the estimated transverse process depth by ultrasound. By ultrasound, the intersection of the middle and lateral thirds of the intercrestal line between the midline and a parallel line through the posterosuperior iliac spine was too lateral to permit needle-transverse process contact in 50% of the subjects. However, moving the transducer 0.75 cm toward the midline allowed for transverse process imaging in all subjects. For psoas compartment blocks/catheters, prepuncture ultrasound imaging accurately predicts transverse process depth to within 1 cm, and if the lumbar plexus is estimated to be within 3 cm of the transverse process, ultrasound allows prediction of maximal lumbar plexus depth to within 1 cm.

Combined Psoas Compartment And Sciatic Block For Lower Extremity Surgery in Two High-Risk Patients

Combined Psoas Compartment And Sciatic Block For Lower Extremity Surgery in Two High-Risk Patients

Advantages of Continuous Psoas Compartment Block for Pain Management of the Lower Extremity

Advantages of Continuous Psoas Compartment Block for Pain Management of the Lower Extremity

A plantar flexion response to nerve stimulation indicates needle misplacement in the epidural/spinal space during psoas compartment block

We report two cases of plantar flexion due to epidural misplacement of the needle during psoas compartment block, providing a response feedback for needle position during this procedure. In one case, the response occurred contralaterally, and in the other bilaterally. In the first patient, the cause of contralateral plantar flexion could not be determined and no injection was made. In the second patient, the anteriorposterior-fluoroscopic image showed that the tip of the needle was placed at the midline of the column. At this point, 3 ml of radiopaque medium was injected, and it diffused throughout the epidural space. Subsequently, single-shot epidural anesthesia was achieved by injection through this needle.

Tramadol Added to Bupivacaine Does Not Prolong Analgesia of Continuous Psoas Compartment Block

The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15). Visual analog scale pain score was not significantly different between the groups during the 48-hour follow-up period. Rescue analgesic consumption, nausea and vomiting, and the satisfaction scores were comparable between the groups (P > 0.05). Success with catheter placement adjacent to the lumbar plexus was 100%, and none of the patients developed any catheter-related complications. In conclusion, tramadol does not provide a clinically significant analgesic action as an adjunct to 0.25% bupivacaine for CPCB.

631: Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB) : Efficacy in Pediatric Complex Pelvic Osteotomy

631: Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB) : Efficacy in Pediatric Complex Pelvic Osteotomy

631. Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB): Efficacy in Pediatric Complex Pelvic Osteotomy

631. Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB): Efficacy in Pediatric Complex Pelvic Osteotomy

Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB): Efficacy in Pediatric Complex Pelvic Osteotomy

Transversus Abdominis Plane Block (TAPB) and Continuous Psoas Compartment Block (CPCB): Efficacy in Pediatric Complex Pelvic Osteotomy

Effects of Using the Posterior or Anterior Approaches to the Lumbar Plexus on the Minimum Effective Anesthetic Concentration (MEAC) of Mepivacaine Required to Block the Femoral Nerve: A Prospective, Randomized, Up-and-Down Study

To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED(50)) was 1.06% +/- 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% +/- 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.

Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy

Study Objectives To compare the clinical effectiveness of two peripheral nerve block techniques combined with sciatic nerve block: sciatic psoas compartment (SPC) and sciatic femoral 3-in-1 (SF 3-in-1) block. Design Prospective, randomized study. Setting Military medical academy hospital. Patients Thirty-six ASA physical status I patients, aged 20 to 33 years, undergoing elective knee arthroscopy. Interventions Patients having SPC block (n = 19) or SF 3-in-1 block (n = 17) received 40 mL of a mixture of solution containing 15 mL of 0.5% bupivacaine, 15 mL of 2.0% prilocaine, and 10 mL of 0.9% sodium chloride. In both groups, the sciatic nerve was blocked with 20 mL of the same solution. An intravenous bolus injection of fentanyl 0.1 mg was used if patients complained of pain. Measurements and Main Results None of the patients in the SPC group experienced pain owing to the applied tourniquet during the operation, whereas 7 patients from the SF 3-in-1 group (41.2 %) reported tourniquet pain. All SF 3-in-1 group patients but only 5 patients (26.3 %) in the SPC group required fentanyl during the operation. In addition, 7 patients in the SF 3-in-1 group required second doses of fentanyl. Patient satisfaction was significantly higher in the SPC group than in the SF 3-in-1 block group ( P < 0.0001). Conclusions Both SPC and SF 3-in-1 provided sufficient anesthetic efficacy for knee arthroscopy. However, SPC may be preferable to SF 3-in-1 block owing to better patient satisfaction and less requirement for opioid analgesics.

Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study

Adequate analgesia is needed after total hip arthroplasty to control pain at rest and during rehabilitation. Our aim was to compare, in a randomized study, the efficacy of two analgesia regimens in control of postoperative pain after total hip arthroplasty: opioid-free continuous psoas compartment block vs. an opioid/non-steroidal anti-inflammatory drugs continuous intravenous infusion. In all, 73 patients (ASA I-III), aged 61-82 yr, undergoing total hip arthroplasty were prospectively enrolled in a single-blind randomized trial. Patients were allocated either to the study group (Group A, n = 37) or to the control group (Group B, n = 36). Patients in Group A underwent preoperative placement of a catheter in the psoas compartment and, 30 min before the end of surgery, the catheter was primed with a loading dose of 0.75% ropivacaine (0.4 mL kg(-1)) followed by a continuous infusion of 10 mL h(-1) ropivacaine 0.2% for 48 h. Patients in Group B received, from 1 h before the end of surgery, a continuous intravenous infusion of 0.1% morphine and 0.12% ketorolac at 2 mL h(-1) for 48 h. Both groups received spinal anaesthesia for surgery. Pain scores at rest and after mobilization, amount of rescue analgesia, nausea/vomiting and haemodynamic parameters were recorded. In Group A, median pain scores were very low during the whole study duration both at rest and during physiotherapy in comparison to Group B. Less rescue analgesia was needed and less nausea and vomiting was observed in Group A. Opioid-free continuous psoas compartment block seems to be an appropriate and reliable technique in providing effective postoperative analgesia at rest and during physiotherapy after total hip arthroplasty when compared to intravenous morphine/ketorolac infusion.

Psoas compartment block

Psoas compartment block (PCB) is a peripheral regional anaesthetic technique that blocks the main components of the lumbar plexus, namely the femoral, lateral femoral cutaneous (LFC), and obturator nerves as they run within the psoas major muscle. The psoas compartment block is also known as the posterior lumbar plexus block. A posterior approach to the lumbar plexus was first described by Winnie and colleagues. They described an approach for ‘lumbosacral’ block but provided no data on the extent of neural block. The term ‘psoas compartment block’ was coined by Chayen and colleagues to describe a loss of resistance technique with injection of solution into the ‘compartment’ between the quadratus lumborum and psoas major muscles. There have been a number of other approaches described since, including an approach by Capdevila and colleagues based on modifications to Winnie’s landmarks using computed tomography.

221: Successfull resuscitation after ropivacaine-lidocaine induced ventricular arrythmia following psoas compartment block in a child

221: Successfull resuscitation after ropivacaine-lidocaine induced ventricular arrythmia following psoas compartment block in a child

Successfull resuscitation after ropivacaine-lidocaine induced ventricular arrythmia following psoas compartment block in a child

Successfull resuscitation after ropivacaine-lidocaine induced ventricular arrythmia following psoas compartment block in a child

The analgesic efficacy of two different approaches to the lumbar plexus for patient-controlled analgesia after total knee replacement

This study assessed the efficacy of a patient-controlled regional analgesia technique for either psoas compartment block or femoral nerve block after total knee replacement in 68 patients who were randomly divided into these two groups. All patients received 40 ml of 0.25% bupivacaine via femoral or psoas catheters before general anesthesia, and then, as patient-controlled regional analgesia, 10-ml boluses of 0.125% bupivacaine, with a lockout time of 60 min over 48 h. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, and side effects were recorded. All measured parameters were comparable in the two groups. Both techniques achieved a good quality of analgesia and satisfaction without any major side effect.

The combination of psoas compartment, sciatic nerve and T12-L1 paravertebral blocks for femoropopliteal bypass surgery in a high risk patient

1Uludag University Department of Anaesthesia and Reanimation, 2Uludag University Department of Cardiovascular Surgery, Bursa, Turkey

Bloc du plexus lombaire par voie postérieure réalisé sous anesthésie générale : étude descriptive de 93 cas

Objectives During many years the approach to the lumbar plexus has been the anterior paravascular technique described as a “3-1” block by Winnie. The posterior approach results in a complete block of the principal nerves of the lumbar plexus. The goal of the study was to evaluate the performance of the psoas compartment block with general anaesthesia. Study design Prospective, descriptive, non randomized study. Patients and methods Ninety-three patients scheduled for hip surgery were studied after informed consent. Demographic data, technical aspects of the puncture, complications, and intra- and postoperative analgesics were recorded. Results The block was performed by resident alone, senior alone, both in respectively 44%, 45, and 11% of cases. The mean duration of the procedure was 6 ± 3 min for the residents, 5 ± 2 min for the seniors, and 9 ± 4 min for both. The transverse process was reach in 72% of cases during the first approach, after reorientation of the needle in the others cases, except 3 failures of attempt. The lumbar plexus was assessed within 60–90 mm of depth, with a median of 75 mm. The motor response was mainly a femoral response; the minimal intensity of stimulation was ranged between 0.3 and 1 mA, with a median of 0.6 mA. The duration of analgesic block was 16.5 ± 4.5 hours, with a median of 18 hours. The morphine use during the first postoperative 24 hours was 8 ± 8 mg, with a median of 5.6 mg. No neurologic complication was recorded at discharge from the hospital. Conclusion The psoas compartment block with general anaesthesia have shown it feasibility and efficiency on intra- and postoperative analgesia during hip surgery.

Analgesia after total hip replacement: epidural versus psoas compartment block

BackgroundThe objective of this paper is to evaluate the effectiveness of a psoas compartment block, as compared with an epidural, for postoperative analgesia following total hip replacement surgery. The research design was a double-blinded randomised control trail, in the setting of a university hospital.MethodsPatients scheduled for hip arthroplasty received either a psoas compartment or epidural infusion of bupivacaine. The outcome measures that were examined were postoperative pain, local anaesthetic and morphine consumption, and side effects.ResultsThere was no significant difference between the two groups regarding postoperative pain. Local anaesthetic and opiate consumption was significantly higher in the psoas compartment block group. Postoperative morphine as covariate had a significant influence on the mean postoperative pain. There was no significant difference between side effects in each group.ConclusionEpidural analgesia was more effective than the psoas compartment block after hip replacement surgery. Although pain did not differ significantly, local anaesthetic and opiate consumption was significantly higher in the psoas compartment group.

Combined Continuous Psoas Compartment Block and Sciatic Nerve Block for Revision Arthroplasty of the Hip in a Patient with Ankylosing Spondylitis - A case report -

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic “bamboo spine” appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.