Article Text

Download PDFPDF
Inguinal Paravascular (Lumbar Plexus) Neurolytic Block—Description of a Catheter Technique: Case Report
  1. Abdullah M. Kaki, M.B.Ch.B., F.R.C.P.C. and
  2. Geraint W. Lewis, M.D., F.R.C.P.C.
  1. From the Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
  1. Reprint requests: Abdullah M. Kaki, M.D., Department of Anaesthesia, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.


Background and Objectives We provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure.

Methods A modified inguinal paravascular (lumbar plexus) block technique was used. A 17-gauge Tuohy needle was inserted in the groin area just lateral to femoral artery and 1 cm below the inguinal ligament. A guide wire was threaded through the needle and subsequently an angiogram catheter was introduced over the wire into the psoas muscle. Radiographic confirmation of the position was obtained, and the catheter was secured in place. A prognostic block using an infusion of 0.25% bupivacaine at 5 mL/h was initiated for the first 2 days. On the third day a neurolytic block with 6% phenol was performed.

Results Marked pain relief was experienced by the patient (VAS: 0-1). Sensory block in the femoral, lateral femoral cutaneous, and obturator nerve distributions was elicited. Motor weakness in the femoral nerve was demonstrated. Narcotic use was markedly reduced, and the patient was discharged to home in a pain-free state.

Conclusions This case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.

  • lumbar plexus
  • inguinal paravascular (3-in-1) block
  • neurolytic block
  • cancer pain.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.