Ultrasound-guided Lumbar Plexus Block Research Articles

Ultrasound-guided lumbar plexus block in children and adolescents using a transverse lumbar paravertebral sonogram: Initial experience.

The clinical reliability and reproducibility of ultrasound-guided lumbar plexus blocks is not established in pediatric populations. We present the results of a combined nerve stimulation ultrasound-guided lumbar plexus block using the vertebral body, transverse process, and psoas muscle as landmarks on a transverse lumbar paravertebral sonogram with mid-axillary transducer placement, "shamrock method," in children and adolescents. Our primary objective was to determine the rate of achieving sensory changes in the lumbar plexus distribution. Secondary outcomes were performance time, reliability of echo-landmarks, measures of patient comfort, and complications. We reviewed prospectively collected quality assurance data and electronic medical records of 21 patients having major orthopedic surgery with lumbar plexus block catheter for postoperative analgesia. Twenty-one patients were studied with mean age and weight (SD, range) of 13.6 years (3.8, 6-18) and 49.3kg (18.6, 19.2-87.6). Surgical procedures included periacetabular osteotomy, pelvic osteotomy, and proximal femoral osteotomy. Mean volume of 0.5mL/kg (0.05) 0.2% ropivacaine produced thermal sensory changes to femoral and lateral femoral cutaneous nerves in 20/21 (95% CI 0.76 to >0.99) and 19/21 (95% CI 0.70-0.99) patients. Identification of transverse process (TP), vertebral body (VB), and psoas muscle (PM): 21/21 (95% CI 0.86-1.0). Average block performance time was 9:08minutes (2:09, 2-13). Average opioid consumption (SD) in operating room, postanesthesia care unit, 0-12 and 12-24-hour periods were 0.17mg/kg (0.08), 0.08mg/kg (0.06), 0.06mg/kg (0.06), and 0.06mg/kg (0.05). Median pain score by severity category in postanesthesia care unit: (0-3) 66.7%, (4-6) 28.5%, (>7) 4.8%; 0-12hours: (0-3) 76.2%, (4-6) 19.0%, (>7) 4.8%; 12-24hours: (0-3) 57.2%, (4-6) 42.8%, (>7) 0%. No complications were recorded. Ultrasound guidance using lateral imaging of transverse process, vertebral body, and psoas muscle allows practitioners to reach the nerves of the lumbar plexus and achieve sensory block in pediatric patients with a high success rate.

Ultrasound-guided supine lumbar plexus block versus iliac fascia block for analgesia in older adult patients undergoing hip replacement: a randomized controlled trial

Background and objectives: Anesthesia is an important part of hip replacement in older adult patients. Lumbar plexus block and iliac fascia block are common block methods in hip replacement. This study will compare the analgesic effects of ultrasound-guided supine lumbar plexus block and multi-angle multi-point iliac fascia block during hip replacement in older adult patients. The result will identify the optimal analgesic regimen. Methods: This prospective, single-center (Lu’an Civily Hospital in China), randomized controlled trial will include 208 older adult patients who are scheduled to undergo hip replacement. The patients will be randomly assigned to one of two groups (n = 104/group). In the lumbar plexus-block group, patients will undergo supine lumbar plexus block, general anesthesia using a laryngeal mask airway, and subsequent hip replacement. In the iliac fascia-block group, patients will undergo multi-angle multi-point iliac fascia block, general anesthesia using a laryngeal mask airway, and subsequent hip replacement. After surgery, all patients will be followed up for 24 hours. Results: The primary outcome measure of this study is a Visual Analog Scale score obtained 24 hours post-surgery, which will be used to evaluate the postoperative analgesic effect. The secondary outcome measures are Visual Analog Scale scores at 2, 6 and 12 hours post-surgery, heart rate at various time points during the surgery (laryngeal mask placement, T0; surgical incision, T1; surgical reaming, T2; prosthesis implantation, T3; incision suture, T4; and resuscitation, T5), mean arterial pressure, blood oxygen saturation, intraoperative sufentanil, perdipine, and ephedrine dosages, total amount of intravenous patient-controlled analgesics at 2, 6, 12, and 24 hours post-surgery, and incidence of adverse reactions. Results of a pilot study involving 60 older adult patients who underwent hip replacement during March 2018 through September 2018 showed that intraoperative sufentanil, perdipine, and ephedrine dosages were significantly lower in the lumbar plexus-block group (n = 30) than in the iliac fascia-block group (n = 30; P Conclusion: Results from this study will provide evidence indicating whether ultrasound-guided supine lumbar plexus block in combination with general anesthesia can more effectively maintain stable hemodynamic indices during hip replacement and whether it results in more encouraging postoperative analgesic effects in older adult patients than multi-angle multi-point iliac fascia block. Ethics and trial registration: This study was approved by the Medical Ethics Committee of Lu’an Civily Hospital in March 2018 (approval No. PJ2018-001). The study protocol version is 1.0. Patients participating in this study will provide their written informed consent after fully understanding the study protocol. This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019888).

Efficacy of quadriceps femoris fasciculation induced by low-current nerve stimulation when used to assist ultrasound-guided lumbar plexus block

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by low-current nerve stimulation when used to assist ultrasound-guided lumbar plexus block. Methods One hundred patients of both sexes, aged 18-45 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, weighing 50-85 kg, scheduled for elective unilateral knee arthroscopy, were selected and randomly divided into 2 groups(n=50 each)using a random number table: ultrasound assisted by nerve stimulator group(group SU)and ultrasound group(group U). The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU, the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture, and 0.5% ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U, when the tip of the nerve stimulating needle was located around the lumbar plexus, which was confirmed by ultrasound, 0.5% ropivacaine 0.4 ml/kg was administrated.The time of puncture, depth of needle insertion, onset time of block and effective block were recorded.Motor block was assessed using the modified knee score, and the development of complications was recorded within 24 h after block. Results Compared with group U, the onset time of block was significantly shortened, the rate of effective block was increased, the degree of motor block was aggravated(P 0.05). No complications were observed in two groups. Conclusion Low-current(0.35 mA)nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block. Key words: Transcutaneous electric nerve stimulation; Ultrasonography; Lumbosacral plexus; Nerve block

Value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block

Objective To evaluate the value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block. Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients who required ultrasound-guided lumbar plexus block, aged 18-60 yr, weighing 55-85 kg, were randomly divided into 3 groups (n=30 each): sterile protective film group (group F), traditional physical method group (group TP) and traditional chemical method group (group TC). The probe was sterilized using a sterile protective film in group F, using a sterile glove in group TP, and using 70%-80% alcohol in group TC.Microbiological detection of probe was carried out subsequently, and the relative sterility was defined as the total number of colonies was less than or equal to 5 cfu/cm2.The time spent in sterilizing probe and in performing lumbar plexus block was recorded.The sterile qualified rates of scanning surface and handle of probe were calculated.The ultrasonic image quality was assessed by using a 4-point scale, and the number of display areas was recorded by Moro method. Results Compared with group TP, the time spent in sterilizing probe and in performing lumbar plexus block was significantly prolonged, the sterile qualified rate of probe handle and ultrasonic image quality were increased, and the number of display areas was increased in group F (P<0.05). Compared with group TC, the time spent in sterilizing probe was significantly shortened, and the sterile qualified rates of scanning surface and handle were increased in group F (P<0.05 or 0.01). Conclusion The probe sterile protective film exerts simple operation, strict sterile effect and little influence on ultrasonic image, the efficacy is superior to that of traditional methods, and it is more suitable for probe sterilization when applied to ultrasound-guided peripheral nerve block. Key words: Ultrasonography; Nerve block; Sterilization

Ultrasound-guided lumbar plexus block in volunteers; a randomized controlled trial

BackgroundThe currently best-established ultrasound-guided lumbar plexus block (LPB) techniques use a paravertebral location of the probe, such as the lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the lumbar plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the lumbar plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock vs LUT. MethodsTwenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine–adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics. ResultsThe shamrock LPB procedure was faster than LUT (238 [sd 74] vs 334 [156] s; P=0.009), more comfortable {numeric rating scale 0–10: 3 [interquartile range (IQR) 2–4] vs 4 [3–6]; P=0.03}, and required fewer needle insertions (2 [IQR 1–3] vs 6 [2–12]; P=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (P=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups. ConclusionsShamrock was faster, more comfortable, and equally effective compared with LUT. Clinical trial registrationNCT02255591.

RETRACTED: Novel lateral approach for ultrasound-guided lumbar plexus block using microconvex Array transducer

RETRACTED: Novel lateral approach for ultrasound-guided lumbar plexus block using microconvex Array transducer

One operator's experience of ultrasound guided lumbar plexus block for paediatric hip surgery.

Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing hip surgery for congenital hip dislocation. After obtaining local institutional ethical committee approval and parental informed consent, ASA I or II, 1-6years old children undergoing hip surgery were included into the study. Lumbar plexus block was performed after general anaesthesia using ultrasound guided Shamrock Method. Bupivacaine 0.25% was used during block performance. Dose of the local anaesthetic was 1ml/kg and the maximum dose was limited to 20ml. In the postoperative period pain was assessed using modified CHEOPS (Children's Hospital Eastern Ontario Pain Scale) pain score. If pain score in the postoperative period exceeded 3, patients received IV paracetamol 15mg/kg-1. Morphine 0.1mg/kg-1 IV was planned to administer if pain scores were still higher than 3 despite paracetamol treatment. 75 patients whose mean age was 47months were enrolled into the study. All blocks were performed successfully and without complications. Mean time for the first analgesic is found as 10h after surgery. Only one patient required morphine in the recovery unit and 23 patients received paracetamol. US guided lumbar plexus block using Shamrock Method is an effective technique for providing postoperative analgesia after hip surgeries in children and it's effect lasts for 8-12h after surgery.

Ultrasound-guided lumbar plexus block using a transverse scan through the lumbar intertransverse space: a prospective case series.

A paramedian transverse scan (PMTS) can be used to delineate the anatomy relevant for ultrasound-guided lumbar plexus block (LPB) through the lumbar intertransverse space. This case series evaluated the feasibility of using the PMTS to guide LPBs for anesthesia. After research ethics committee approval and written informed consent, 15 American Society of Anesthesiologists physical status 1 to III patients with body mass index of less than 35 kg/m scheduled for lower-extremity surgery received an ultrasound-guided LPB and a sciatic nerve block for anesthesia. The blocks were performed using the PMTS and in-plane needle insertion. Localization of the lumbar plexus was confirmed by obtaining quadriceps muscle twitch. Successful blocks were defined as adequate anesthesia for lower-extremity surgery in the sensory territory of the lumbar plexus. The articular process and psoas muscle were visualized on ultrasound in all 15 patients (mean age, 46.3 ± 20.4 years; body mass index, 22.2 ± 2.4 kg/m), but the lumbar plexus was identified in two-thirds of the patients. Blocks were successfully performed in 14 (93%) of the 15 patients. Poor visibility in 1 patient (7%) precluded the use of ultrasound guidance. The needle was visualized in the psoas muscle in 14 patients (93%), whereas proper needle location was confirmed in all patients by nerve stimulation. Needle to lumbar plexus contact was delineated on ultrasound in 8 (53%) and 14 patients (93%), before and after injection of local anesthetic, respectively. Adequate anesthesia was accomplished in all patients within 30 minutes of injection. Ultrasound-guided LPBs can be reliably accomplished using the PMTS.

The Comparing of Ultrasound-guided Techniques: Sciatic Block with Continuous Lumbar Plexus Block or Continuous Femoral Nerve Block for Anesthesia and Analgesia of Total knee Replacement

Background and Aims: This double blind prospective randomized clinical trial evaluated the efficacy and safety of continuous ultrasound-guided lumbar plexus block compared to continuous ultrasound-guided femoral nerve block, in the intra-operative and postoperative periods after total knee replacement. Methods: Forty ASA I-III patients were randomized to receive: continuous femoral block (n= 20, 30 ml of ropivacaine 5 mg/ml) or continuous lumbar plexus block (n= 20, 30 ml of ropivacaine 5 mg/ml) both in association with single injection sciatic nerve block. All patients received continuous infusion of 2 mg/ml of ropivacaine at 8 ml/h for 48 hours and intravenous morphine for patient-controlled analgesia. Primary outcomes were intra-operative sufentanil consumption and verbal analogue scale (VAS) score at rest at 24h follow up. Results: Intra-operative sufentanil consumption was higher in the femoral block (FEM) group compared to the lumbar plexus block (PSOAS) group (FEM: 10.00 (10.00, 17.50) µg; PSOAS: 2.50 (0.00, 10.00) µg. p= 0.002). Obturator motor blockade occurred more frequently in the PSOAS group (70%) than in the FEM group (40%) (p=0.1); however, we found no differences in sensory blockade (p=0.6). VAS at rest was similar in the two groups at 24h postoperatively (FEM: 29.50 ± 14.74 mm; PSOAS: 25.60 ±17.42 mm. p=0.4), and throughout the follow-up period. No differences were detected in pain scores during physiotherapy. Conclusion: Continuous femoral and lumbar plexus blocks, both in association with sciatic nerve block, provided similar VAS scores at 24h, and throughout the follow-up period; intra-operative sufentanil consumption was, however, lower in the lumbar plexus block group.