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Diwan S, Feigl G, Shivaprakash S, Areti A. Dissimilar Planes and Approaches with Common Neural Targets - A Cadaveric Evaluation of Three Different Ultrasound-guided Fascial Plane Blocks for Lumbar Plexus Nerves. J Med Ultrasound 2024; 32:227-232. [PMID: 39310877 PMCID: PMC11414952 DOI: 10.4103/jmu.jmu_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/28/2023] [Accepted: 10/30/2023] [Indexed: 09/25/2024] Open
Abstract
Background The lumbar plexus (LP) is a group of nerves located at the fourth lumbar vertebra level, between the anterior two-thirds and posterior one-thirds of the psoas muscle. In this study, the researchers aimed to investigate the spread of latex in injections of LP, suprainguinal fascia iliaca, and circum-psoas planes to assess the different regional techniques for blocking LP nerves (LPNs). Methods The study involved performing ultrasound-guided injections of three different colored latexes in six cadavers. The researchers observed and compared the spread of latex in each plane by taking cross sections at the levels of L4, anterior superior iliac spine (ASIS), and sacral foramina (SF). The spread of latex and LPN staining was documented and analyzed through photography. Results The results showed that the latex spread within the psoas muscle and fascia iliaca plane (FIP) during LP injections, whereas suprainguinal fascia iliaca injections showed latex dissemination in the FIP at both ASIS and SF levels. On the other hand, circum-psoas injections spread beneath the iliopsoas fascia at both levels and medially toward the external iliac vessels. Despite this spread, there was no communication between the three planes, and there was no mixing of latex from the different injections at any level. Conclusion There are distinct fascial planes, for the three approaches, with no communication between them. While latex diffused from LP plane to FIP, no mixing of dye was observed and also the reverse could not be achieved. These findings suggest that different regional techniques for blocking LPNs have their unique planes of action.
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Affiliation(s)
- Sandeep Diwan
- Department of Anesthesiology, Sancheti Hospital for Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Georg Feigl
- Department of Anesthesiology, Institute of Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany
| | - S. Shivaprakash
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Archana Areti
- Department of Anesthesiology, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
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Hu J, Li X, Wang Q, Yang J. Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744461. [PMID: 37657517 DOI: 10.1016/j.bjane.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). METHODS A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. RESULTS Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. CONCLUSIONS For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
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Affiliation(s)
- Jian Hu
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China
| | - Xingcheng Li
- Sichuan University, West China School of Nursing, West China Tianfu Hospital, Department of Urology, Chengdu, China
| | - Qiuru Wang
- Sichuan University, West China Hospital, Department of Orthopedic Surgery, Chengdu, China
| | - Jing Yang
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China.
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Souvatzoglou R, Saranteas T, Poulogiannopoulou E, Mavrogenis AF. Ultrasound-Guided Peripheral Nerve Blocks for Hip Surgery: A Concise Perspective. J Long Term Eff Med Implants 2024; 34:49-58. [PMID: 37938205 DOI: 10.1615/jlongtermeffmedimplants.2023045538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Ultrasound implementation for the facilitation of peripheral nerve blocks is well established. Ultrasound-guided lumbar plexus, femoral, fascia iliaca and supra-inguinal fascia iliaca compartment, pericapsular nerve group and quadratus lumborum nerve blocks have been employed for analgesia purposes in hip surgery. The combination of motor-sparing regional anesthesia strategies for optimal postoperative pain control with recovery protocols targeting to early and safe patients' mobilization constitute the current dogma of orthopedic surgery. Therefore, this editorial sets out to revisit the role of peripheral nerve blocks in postoperative pain management of hip surgery patients, under the prism of current orthopedic practice.
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Affiliation(s)
- Rizos Souvatzoglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleni Poulogiannopoulou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Lee TY, Chung CJ, Park SY. Comparing the Pericapsular Nerve Group Block and the Lumbar Plexus Block for Hip Fracture Surgery: A Single-Center Randomized Double-Blinded Study. J Clin Med 2023; 13:122. [PMID: 38202129 PMCID: PMC10779740 DOI: 10.3390/jcm13010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Lumbar plexus blocks (LPBs) are routinely employed for analgesia in hip fracture surgery; however, a novel regional technique, the pericapsular nerve group (PENG) block, potentially offers comparable pain reduction while preserving motor function. Patients aged 45-90 years who underwent hip fracture surgery were allocated to receive either a PENG block or an LPB for analgesia. The primary outcome was the incidence of quadriceps motor block (defined as the paresis or paralysis of the knee extension) at 12 h postoperatively. The secondary outcomes included the performance time, the time to first analgesic requirement, postoperative intravenous (IV) fentanyl consumption, the ability to undergo physiotherapy at 24 and 48 h, complications, sensory and motor block assessments, postoperative numeric rating scale (NRS) pain scores, and patient outcome questionnaires. There was a significantly lower incidence of quadriceps motor block at 6 h (26.7% vs. 80.0%; p < 0.001) and at 12 h (20.0% vs. 56.7%; p = 0.010). The PENG block provided better preservation of the sensory block as well as better performance time (p < 0.001) and time to first analgesia requirement (p = 0.034), whereas the LPB resulted in lower postoperative IV fentanyl consumption at 24 h (p = 0.013). The PENG block demonstrated superiority over the LPB in preserving quadriceps strength and patient satisfaction without any substantial complications, despite higher opioid consumption within the first 24 h post-surgery.
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Affiliation(s)
| | | | - Sang Yoong Park
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan 49201, Republic of Korea; (T.Y.L.); (C.J.C.)
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Abouelgreed TA, Elgarhy AM, Elatreisy A, Ewieda TM, Ibrahim WM, Yahia OS, Elnaggar AM, Elbadawy MA, Alkumity AA, Badran Y, Ali M, Gomaa A, Elebiary MF, Aboelnasr M. Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy? Arch Ital Urol Androl 2023; 95:11584. [PMID: 37791553 DOI: 10.4081/aiua.2023.11584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. PATIENTS AND METHODS A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. RESULTS None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. CONCLUSIONS Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements.
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Affiliation(s)
| | | | - Adel Elatreisy
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | | | | | | | | | | | | | - Yasser Badran
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mahmoud Ali
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Aly Gomaa
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mohame F Elebiary
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mahmoud Aboelnasr
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
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Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals. J Pediatr Orthop 2023; 43:e54-e59. [PMID: 36509456 DOI: 10.1097/bpo.0000000000002285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques. METHODS This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups. RESULTS Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P<0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P<0.01. CONCLUSION The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population. LEVEL OF EVIDENCE Level III-Case control or retrospective comparative study.
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He WQ, Li YJ, Li YS, Zhang XH, Cao J, Lu KZ, Cheung CW, Gu JT, Xia ZY, Yi B. Advantages of Transmuscular Quadratus Lumborum Block via Subfascial Approach Versus Extrafascial Approach for Postoperative Analgesia After Laparoscopic Cholecystectomy: A Randomized Controlled Study. Clin J Pain 2022; 38:730-738. [PMID: 36221155 PMCID: PMC9645534 DOI: 10.1097/ajp.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/22/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC). METHODS Eighty patients undergoing LC were randomized to receive ultrasound-guided bilateral TQL block via subfascial (subfascial group) or extrafascial (extrafascial group) using 30 mL of 0.33% ropivacaine unilaterally. Pain scores of port sites while rest and coughing at 1, 6, 12, 24, 36, and 48 hours postoperatively as primary outcome were compared. Modified Lovett Rating Scale, ambulatory dependency, and rescue analgesia requirement was also compared. RESULTS The pain score of the subxiphoid and of the right subcostal port site for up to the postoperative 36 hours (2 [1 to 2]) and 24 hours (2 [2 to 3]) in the subfascial group was significantly lower than that in extrafascial group (2 [2 to 2] and 3 [2.25 to 4]). Up to postoperative 24 hours, the rescue analgesia requirement in subfascial group was significantly lower than that in extrafascial group, namely less fentanyl consumption and parecoxib (1.3 [±5.5] μg vs. 5.6 [±10.6] μg; 17.5% vs. 37.5%). The ratio of patients with LRS score of 6 at postoperative 1 hour (65.0%), and with dependent ambulation at postoperative 1 and 6 hours in subfascial group (15.0% and 0.0%) was significantly lower than that in extrafascial group (10.0%, 80.0%, and 17.5%). CONCLUSION TQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.
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Affiliation(s)
- Wen-quan He
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yu-jie Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yong-shuai Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Xu-hao Zhang
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Jian Cao
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Kai-zhi Lu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, University of Hong Kong, HKSAR
| | - Jian-teng Gu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Zheng-yuan Xia
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bin Yi
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
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Li H, Shi R, Shao P, Wang Y. Evaluation of Sensory Loss Obtained by Circum-Psoas Blocks in Patients Undergoing Total Hip Replacement: A Descriptive Pilot Study. J Pain Res 2022; 15:827-835. [PMID: 35378731 PMCID: PMC8976501 DOI: 10.2147/jpr.s354829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion Clinical Trial Registration
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Affiliation(s)
- Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
- Correspondence: Yun Wang, Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China, Tel +86-10-85231330, Email
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Saranteas T, Souvatzoglou R, Kostroglou A, Sioutis S, Christodoulaki K, Koulalis D, Soulioti E, Papadimos T, Mavrogenis A. A lumbar paravertebral space ultrasound lumbar plexus block technique for hip fracture surgery in the elderly. J Long Term Eff Med Implants 2022; 32:65-71. [DOI: 10.1615/jlongtermeffmedimplants.2022042501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Brixel SM, Biboulet P, Swisser F, Choquet O, Aarab Y, Nguyen H, Bringuier S, Capdevila X. Posterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial. Anesthesiology 2021; 134:722-733. [PMID: 33740816 DOI: 10.1097/aln.0000000000003745] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty. METHODS This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events. RESULTS There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (β = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events. CONCLUSIONS After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen. EDITOR’S PERSPECTIVE
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Continuous Lumbar Plexus Block vs Continuous Lumbar Erector Spinae Plane Block for Postoperative Pain Control After Revision Total Hip Arthroplasty. Arthroplast Today 2021; 9:29-34. [PMID: 33997205 PMCID: PMC8099915 DOI: 10.1016/j.artd.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Optimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty. Material and methods We compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting. Results There was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively, P = .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively, P = .42). Conclusions There was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.
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Stebler K, Choquet O, Bernard N, Biboulet P, Capdevila X. An uncommon cause of nerve stimulator's malfunction during a dual guidance lumbar plexus block: A technical brief report and an algorithm for prevention of complications. Anaesth Crit Care Pain Med 2021; 40:100832. [PMID: 33744494 DOI: 10.1016/j.accpm.2021.100832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Posterior Lumbar plexus block (PLPB) combined with an ipsilateral sacral plexus block is a valuable anaesthetic technique in patients undergoing hip fracture surgery. PLPB is performed through the acoustic window of the lumbar ultrasound trident and the position of the needle tip, before injection of LA, was confirmed by observing quadriceps femoris muscle contraction to peripheral nerve stimulation (i.e., dual guidance). We report an uncommon cause of nerve stimulator malfunction that might impair block performance and promote complications. We add an algorithm to limit the risk of complications.
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Affiliation(s)
- Kevin Stebler
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Olivier Choquet
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Nathalie Bernard
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Philippe Biboulet
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France.
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Seidel R, Barbakow E, Schulz-Drost S. Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia : A prospective feasibility study. Anaesthesist 2021; 70:1022-1030. [PMID: 33713157 DOI: 10.1007/s00101-021-00935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE 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 a combined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture. METHODS We used a unilateral 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). RESULTS In 42% of cases the surgery was opioid-free (n = 33). In 5 patients a conversion to general anesthesia (insertion of a laryngeal 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. CONCLUSION 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.
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Affiliation(s)
- Ronald Seidel
- Department of Anesthesiology and Intensive Care, Asklepios Medical Center Schwedt/Oder, Am Klinikum 1, 16303, Schwedt, Germany.
| | - Eduard Barbakow
- Department of Anesthesiology, Helios Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany
| | - Stefan Schulz-Drost
- Department for Trauma and Reconstructive Surgery, Helios Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany
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Hitka T, O'Sullivan J, Szucs S, Iohom G. Determination of the initial minimum effective dose of 0.5% bupivacaine with 20 μg of fentanyl for an operative fixation of fractured neck of femur: a prospective, observational trial. Minerva Anestesiol 2021; 87:766-773. [PMID: 33591143 DOI: 10.23736/s0375-9393.21.15012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fractured neck of femur (FNF) is a common cause of morbidity and mortality in elderly. Spinal catheter allows fractionation of local anesthetic dose which combined with intrathecal opioid leads to a dose reduction and better hemodynamic stability. The primary objective of this paper was to investigate the initial minimum local anesthetic dose (iMLAD) of 0.5% isobaric bupivacaine with 20 μg of fentanyl administered via spinal catheter in order to commence the operative fixation of FNF. METHODS A prospective, single-blinded, adaptive clinical trial with patients undergoing dynamic hip screw implantation (DHS) or hemiarthroplasty (HEMI) due to FNF. The Dixon and Massey's up and down method was used to determine the ED50 of intrathecal bupivacaine. This figure was confirmed with Probit analysis, in addition to the ED95. RESULTS Using the Dixon and Massey's approach, the iMLADED50 for DHS was 0.29 mL (1.45 mg) and the iMLADED50 for HEMI was 0.33 mL (1.65 mg) of 0.5% isobaric bupivacaine. The Probit analyses demonstrated that the iMLADED95 for DHS and HEMI were 0.32 mL (1.6 mg) and 0.34 mL (1.7 mg) respectively. The mean cumulative dose of 0.5% bupivacaine for the whole surgery was 0.67 mL (3.35 mg) and 0.87 mL (4.35 mg) in the DHS and HEMI groups, respectively. CONCLUSIONS This study demonstrates that the placement of a spinal catheter allows for careful titration of local anesthetic, enabling a reduction of the initial intrathecal dose of 0.5% isobaric bupivacaine below 0.4 mL (2 mg) and leading to a significant reduction of a dose required for the whole surgery when combined with an intrathecal opioid.
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Affiliation(s)
- Tomas Hitka
- Department of Anesthesia and Intensive Care, Cork University Hospital, Cork, Ireland -
| | - Jane O'Sullivan
- Department of Anesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Szilard Szucs
- Department of Anesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
| | - Gabriella Iohom
- Cork University Hospital, Cork, Ireland.,University College of Cork, Cork, Ireland
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Huang C, Zhang X, Dong C, Lian C, Li J, Yu L. Postoperative analgesic effects of the quadratus lumborum block III and transversalis fascia plane block in paediatric patients with developmental dysplasia of the hip undergoing open reduction surgeries: a double-blinded randomised controlled trial. BMJ Open 2021; 11:e038992. [PMID: 33542037 PMCID: PMC7925863 DOI: 10.1136/bmjopen-2020-038992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the analgesic effectiveness of two novel regional nerve blocks in paediatric patients with developmental dysplasia of the hip (DDH) after open reduction surgeries. DESIGN Prospective, double-blinded, randomised controlled trial. SETTING 2 tertiary teaching hospitals in China between August 2017 and July 2018. PARTICIPANTS 110 paediatric patients aged 2-10 years with DDH undergoing open reduction surgeries were recruited, 95 were randomised and 90 were included in the final analysis. INTERVENTIONS Random assignment to quadratus lumborum block III (QLB III) group, transversalis fascia plane block (TFPB) group and the control (no region nerve block) group. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the Face, Legs, Activity, Cry and Consolability (FLACC) Scale Scores. Secondary outcomes included perioperative opioid consumption, the time until first press of nurse-controlled analgesia/patient-controlled analgesia (NCA/PCA) pump and the total counts number of pressing, length of postanaesthesia care unit (PACU) stay, length of hospital stay, parental satisfaction with pain management and adverse events. RESULTS Mean FLACC Scores were significantly lower in QLB III group and TFPB group while in the PACU and for 48 hours postoperatively, compared with control group (p<0.0001, p<0.0001, respectively). No differences were found for FLACC Scores between QLB III group and TFPB group, neither at rest (p=0.0402) nor while posture changing (p=0.0306). TFPB prolonged the first-time request for NCA/PCA analgesia, and decreased the total number of pressing counts, compared with QLB III (22.5 (16.2 to 28.7) vs 11.7 (6.6 to 16.8), p<0.0001; 2.4 (1.3 to 3.6) vs 3.8 (2.8 to 4.8), p=0.0111, respectively). No patient experienced any adverse events. CONCLUSIONS We suggested that both ultrasound-guided QLB III and TFPB should be considered as an option for perioperative analgesia in children with DDH undergoing open reduction surgeries. TFPB was superior to the QLB III because it prolonged the first-time request for NCA/PCA analgesia and decreased the total counts number of pressing. TRIAL REGISTRATION NUMBER NCT03189966/2017.
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Affiliation(s)
- Congcong Huang
- Department of Pain Management, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoguang Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Chaoxuan Dong
- Department of Anesthesiology, First Affiliated Hospital of Jinan University and Guangzhou Overseas Chinese Hospital, Guangzhou, Guangdong, China
| | - Chunwei Lian
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lingzhi Yu
- Department of Pain Management, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
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16
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Bravo D, Layera S, Aliste J, Jara Á, Fernández D, Barrientos C, Wulf R, Muñoz G, Finlayson RJ, Tran DQ. Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial. J Clin Anesth 2020; 66:109907. [DOI: 10.1016/j.jclinane.2020.109907] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
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17
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Andersen CHS, Laier GH, Nielsen MV, Dam M, Hansen CK, Tanggaard K, Børglum J. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy: Study protocol for a dose-finding trial. Acta Anaesthesiol Scand 2020; 64:1224-1228. [PMID: 32297653 DOI: 10.1111/aas.13605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The objective of this trial is to optimize the transmuscular quadratus lumborum (TQL) block, by investigating the minimal effective volume (MEV90 ) of ropivacaine 0.75% for single-shot TQL block in percutaneous nephrolithotomy (PNL) patients. METHODS This double-blind, randomized and controlled dose-finding trial is based on a biased coin up-and-down sequential design, where the volume of local anaesthetic administered to each patient depends on the response from the previous one. Investigating the TQL block, the first patient recruited receives 20 ml ropivacaine 0.75% preoperatively. In case of block failure, the next patient will receive the same volume with an increment of 2 ml. Given a successful block for the first patient, the next patient will be randomized to either a lower volume (previous volume with a reduction of 2 ml), or the same volume as the previous patient. The respective probabilities being b = 0.11 for a reduced volume and 1-b = 0.89 for the same volume. Block success is defined as patient reported pain score numeric rated scale (NRS) ≤3 (0-10/10) 30 minutes after arrival in the post anaesthesia care unit (PACU). The NRS pain score is our primary and only outcome for block success. A minimum of 25 eligible patients are needed to achieve precise estimation of MEV90 with narrow 95% confidence intervals derived by bootstrapping. DISCUSSION Recruiting will begin June 2020 and is expected to finish November 2020. Data analysis will be performed at interims during and after the study. Results will be published in an international peer-reviewed medical journal.
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Affiliation(s)
| | - Gunnar H. Laier
- Production, Research and Innovation Region Sjaelland Soro Denmark
| | - Martin V. Nielsen
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Mette Dam
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Christian K. Hansen
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Katrine Tanggaard
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Jens Børglum
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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18
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Chen L, Ji J, Tian Y, Sun Q, Qiu X, Li X, Li B. Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy. BMC Anesthesiol 2020; 20:217. [PMID: 32867683 PMCID: PMC7457541 DOI: 10.1186/s12871-020-01134-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL). Methods The medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well. Results The static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups. Conclusions QLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.
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Affiliation(s)
- Luning Chen
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Jingjing Ji
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Yali Tian
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Qing Sun
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xuefeng Qiu
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xiaogong Li
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Bingbing Li
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China.
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19
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Talawar P, Tandon S, Tripathy DK, Kaushal A. Combined pericapsular nerve group and lateral femoral cutaneous nerve blocks for surgical anaesthesia in hip arthroscopy. Indian J Anaesth 2020; 64:638-640. [PMID: 32792743 PMCID: PMC7413353 DOI: 10.4103/ija.ija_57_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/23/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Praveen Talawar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shipra Tandon
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - D K Tripathy
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Kaushal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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20
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Genç Moralar D, Tok Cekmecelioglu B, Aslan M, Hergünsel GO. Effect of quadratus lumborum block on postoperative analgesic requirements in pediatric patients: a randomized controlled double-blinded study. Minerva Anestesiol 2020; 86:150-156. [DOI: 10.23736/s0375-9393.19.13361-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Lu Y, Zhang J, Xu X, Chen W, Zhang S, Zheng H, Xia Y, Papadimos TJ, Xu X, Chen H. Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial. Minerva Anestesiol 2019; 85:1273-1280. [DOI: 10.23736/s0375-9393.19.13656-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol 2019; 33:539-551. [DOI: 10.1016/j.bpa.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
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23
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Aksu C, Şen MC, Akay MA, Baydemir C, Gürkan Y. Erector Spinae Plane Block vs Quadratus Lumborum Block for pediatric lower abdominal surgery: A double blinded, prospective, and randomized trial. J Clin Anesth 2019; 57:24-28. [DOI: 10.1016/j.jclinane.2019.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 03/03/2019] [Indexed: 12/24/2022]
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24
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Ahmed A, Fawzy M, Nasr MAR, Hussam AM, Fouad E, Aboeldahb H, Saad D, Osman S, Fahmy RS, Farid M, Waheb MM. Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches. BMC Anesthesiol 2019; 19:184. [PMID: 31623572 PMCID: PMC6798412 DOI: 10.1186/s12871-019-0862-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/30/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. METHODS Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. RESULTS Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. CONCLUSIONS Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03526731 - on 16 May 2018.
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Affiliation(s)
- Abeer Ahmed
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Maher Fawzy
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Mohamed A. R. Nasr
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Ayman M. Hussam
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Eman Fouad
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Hesham Aboeldahb
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Dalia Saad
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Safinaz Osman
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Rania Samir Fahmy
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Mohamed Farid
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
| | - Mohsen M. Waheb
- Department of Anesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University, 01 El Sarayah street, El Manyal, Cairo, 11559 Egypt
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25
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Kåsine T, Romundstad L, Rosseland LA, Ullensvang K, Fagerland MW, Kessler P, Bjørnå E, Sauter AR. The effect of needle tip tracking on procedural time of ultrasound‐guided lumbar plexus block: a randomised controlled trial. Anaesthesia 2019; 75:72-79. [DOI: 10.1111/anae.14846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Kåsine
- Department of Anaesthesia Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - L. Romundstad
- Department of Anaesthesia Oslo University Hospital Oslo Norway
| | - L. A. Rosseland
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - K. Ullensvang
- Department of Anaesthesia Oslo University Hospital Oslo Norway
| | - M. W. Fagerland
- Oslo Centre for Biostatistics and Epidemiology (OCBE) Research Support Services Oslo University Hospital Oslo Norway
| | - P. Kessler
- Department of Anaesthesia, Intensive Care and Pain Medicine Orthopedic University Hospital Friedrichsheim Frankfurt Germany
| | - E. Bjørnå
- Department of Anaesthesia Oslo University Hospital Oslo Norway
| | - A. R. Sauter
- Department of Anaesthesia Oslo University Hospital Oslo Norway
- Department of Anaesthesia and Pain Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland
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26
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Hansen CK, Dam M, Steingrimsdottir GE, Laier GH, Lebech M, Poulsen TD, Chan VWS, Wolmarans M, Bendtsen TF, Børglum J. Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial. Reg Anesth Pain Med 2019; 44:rapm-2019-100540. [PMID: 31308263 DOI: 10.1136/rapm-2019-100540] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Elective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS. METHODS A randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated. RESULTS Opioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03. CONCLUSIONS Bilateral TQL block significantly reduced 24 hours' opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.
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Affiliation(s)
- Christian K Hansen
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Dam
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Morten Lebech
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
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27
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Pangthipampai P, Tangwiwat S, Pakpirom J, Songthamwat B, Karmakar MK. Ultrasound visualization of the anatomy relevant for lumbar plexus block: comparison of the paramedian transverse and Shamrock scan technique. Reg Anesth Pain Med 2019; 44:rapm-2018-100011. [PMID: 30886068 DOI: 10.1136/rapm-2018-100011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Pawinee Pangthipampai
- Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jatuporn Pakpirom
- Department of Anesthesiology, Prince of Songkla University, Hat Yai, Thailand
| | - Banchobporn Songthamwat
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand
| | - Manoj Kumar Karmakar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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28
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Seidel R, Barbakow E. [Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia : A clinical case series]. Anaesthesist 2019; 68:108-114. [PMID: 30721327 DOI: 10.1007/s00101-019-0537-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/23/2018] [Accepted: 12/24/2018] [Indexed: 11/30/2022]
Abstract
The authors describe in a clinical case series (n = 7) of older (age 78-95 years) high-risk patients the successful surgical treatment of proximal femoral fractures in a peripheral regional anesthesia technique. After positioning on the non-fractured side, a double injection technique (dual guidance concept: sonography plus nerve stimulation) was chosen. The injections were performed parasacrally (blockade of the sacral plexus under the piriformis muscle) and lumbar-paravertebrally (psoas compartment block and transmuscular quadratus lumborum block). Per block 15 ml ropivacaine 0.5% or 20 ml ropivacaine 0.375% was administered. The total dose of 225 mg ropivacaine was never exceeded. In 5 out of 7 cases a supplemental medication with 2 times 5 μg sufentanil (n = 2) and/or 1-1.5 mg/kg body weight and h propofol (n = 4) was administered with spontaneous breathing. In addition to potential benefits, the authors also discuss limitations of the procedure, for example by the use of oral anticoagulants.
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Affiliation(s)
- R Seidel
- Klinik für Anästhesiologie, HELIOS-Kliniken Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Deutschland.
| | - E Barbakow
- Klinik für Anästhesiologie, HELIOS-Kliniken Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Deutschland
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Abstract
A review of anatomy, potential mechanisms of action, and techniques and summary of clinical evidence for quadratus lumborum block.
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30
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Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block. Eur J Anaesthesiol 2018; 35:803-805. [PMID: 30192264 DOI: 10.1097/eja.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin 2018; 36:403-415. [PMID: 30092937 DOI: 10.1016/j.anclin.2018.04.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Other techniques, such as selective obturator and/or lateral femoral cutaneous nerve blocks, represent alternatives. Newer approaches, such as quadratus lumborum block and local infiltration analgesia, require rigorous studies. To realize long-term outcome benefits, postoperative regional analgesia must be tailored to the individual patient and last longer.
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Affiliation(s)
- Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy.
| | - Valentina Bellini
- Department of Anesthesia and Pain Therapy, Parma University Hospital, Via Gramsci, 14, Parma 43126, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA
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32
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Yörükoğlu UH, Gürkan Y. Combined quadratus lumborum block and lumbar plexus block for a pediatric patient undergoing Ilizarov procedure. J Clin Anesth 2018; 49:40-41. [PMID: 29883967 DOI: 10.1016/j.jclinane.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/18/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Ufuk H Yörükoğlu
- Department of Anesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli, Turkey
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33
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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block. Eur J Anaesthesiol 2018; 35:224-230. [DOI: 10.1097/eja.0000000000000736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Suresh S, De Oliveira G. Local anaesthetic dosage of peripheral nerve blocks in children: analysis of 40 121 blocks from the Pediatric Regional Anesthesia Network database. Br J Anaesth 2018; 120:317-322. [DOI: 10.1016/j.bja.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/27/2017] [Accepted: 12/01/2017] [Indexed: 12/21/2022] Open
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35
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Advances of Techniques in Deep Regional Blocks. BIOMED RESEARCH INTERNATIONAL 2018; 2017:7268308. [PMID: 29349079 PMCID: PMC5733986 DOI: 10.1155/2017/7268308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/17/2022]
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36
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Reply to: importance of half-the-air pressure test in Shamrock lumbar plexus block. Eur J Anaesthesiol 2018; 33:784-5. [PMID: 27096903 DOI: 10.1097/eja.0000000000000466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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38
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Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study. Anesth Analg 2017; 125:303-312. [PMID: 28277325 DOI: 10.1213/ane.0000000000001922] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1873209. [PMID: 28396863 PMCID: PMC5371225 DOI: 10.1155/2017/1873209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/29/2017] [Indexed: 01/06/2023]
Abstract
Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21–36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552–1023] versus 196 [167–228], p < 0.001 and 333 [254–439] versus 216 [176–294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
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Strid J, Sauter A, Ullensvang K, Andersen M, Daugaard M, Bendtsen M, Søballe K, Pedersen E, Børglum J, Bendtsen T. Ultrasound-guided lumbar plexus block in volunteers; a randomized controlled trial. Br J Anaesth 2017; 118:430-438. [DOI: 10.1093/bja/aew464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
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41
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Lee BH, Braehler M. Use of test dose allows early detection of subdural local anesthetic injection with lumbar plexus block. J Clin Anesth 2017; 37:111-113. [PMID: 28235496 DOI: 10.1016/j.jclinane.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/19/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
A 56year-old woman underwent a lumbar plexus block for a revision of a left total hip arthroplasty. During the block procedure, the needle was advanced over the transverse process and isolated quadriceps twitches were elicited. After administering a test dose of 3ml of 1.5% lidocaine, the patient developed loss of sensation in the L3-4 dermatomal distribution that progressed caudally to involve both legs followed by inability to move the left leg. The patient shortly thereafter became hypotensive and sensory block spread cephalad and peaked at C7 bilaterally suggesting possible subdural spread of local anesthetic. The patient was resuscitated with normalization of blood pressure and eventually had full resolution of motor and sensory block. Subdural spread of local anesthetic is a potential complication of lumbar plexus block related perhaps to injection of local anesthetic near dural sleeves of nerve roots. The use of a test dose allows early recognition of subdural injection and may limit consequences of inadvertent subdural spread of local anesthetic.
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Affiliation(s)
- Bradley H Lee
- University of California, San Francisco, United States.
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Tsui BC. "PQRST": the shamrock method for lumbar plexus blocks. J Clin Monit Comput 2016; 31:1333-1334. [PMID: 27885539 DOI: 10.1007/s10877-016-9964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- B C Tsui
- Stanford University, Palo Alto, CA, USA.
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Novel lateral approach for ultrasound-guided lumbar plexus block using microconvex Array transducer. J Clin Anesth 2016; 32:194-195. [PMID: 27290973 DOI: 10.1016/j.jclinane.2016.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
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44
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Gürkan Y, Aksu C, Kuş A, Toker K, Solak M. One operator’s experience of ultrasound guided lumbar plexus block for paediatric hip surgery. J Clin Monit Comput 2016; 31:331-336. [DOI: 10.1007/s10877-016-9869-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
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45
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Chakraborty A, Khemka R, Datta T. Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia. Indian J Anaesth 2016; 60:703-711. [PMID: 27761032 PMCID: PMC5064693 DOI: 10.4103/0019-5049.191665] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The practice of regional anaesthesia is rapidly changing with the introduction of ultrasound into the working domain of the anaesthesiologist. New techniques are being pioneered. Among the recent techniques, notable are the truncal blocks, for example, the transversus abdominis plane block, rectus sheath block, hernia block and quadratus lumborum block in the abdomen and the pectoral nerves (Pecs) block 1 and 2, serratus anterior plane block and intercostal nerve block. This narrative review covers the brief anatomical discourse along with technical description of the ultrasound-guided truncal blocks.
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Affiliation(s)
| | - Rakhi Khemka
- Tata Medical Center, Kolkata, West Bengal, India
| | - Taniya Datta
- Tata Medical Center, Kolkata, West Bengal, India
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46
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Hansen CK, Dam M, Bendtsen TF, Børglum J. Ultrasound-Guided Quadratus Lumborum Blocks. ACTA ACUST UNITED AC 2016; 6:39. [DOI: 10.1213/xaa.0000000000000270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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