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Effects of Using the Posterior or Anterior Approaches to the Lumbar Plexus on the Minimum Effective Anesthetic Concentration (MEAC) of Mepivacaine Required to Block the Femoral Nerve: A Prospective, Randomized, Up-and-Down Study
  1. Gianluca Cappelleri, M.D.a,
  2. Giorgio Aldegheri, M.D.a,
  3. Francesco Ruggieri, M.D.c,
  4. Franco Carnelli, M.D.b,
  5. Andrea Fanelli, M.D.d and
  6. Andrea Casati, M.D.d
  1. aDepartment of Anaesthesiology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Multimedica, Sesto San Giovanni, Milano, Italy
  2. bDepartment of Orthopedics, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Multimedica, Sesto San Giovanni, Milano, Italy
  3. cDepartment of Anaesthesia and Pain Therapy, Vita-Salute University-San Raffaele Hospital, Milano, Italy
  4. dDepartment of Anaesthesia and Pain Therapy, University of Parma-Ospedale Maggiore di Parma, Parma, Italy.

Abstract

Background and Objectives: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block.

Methods: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%).

Results: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED50) was 1.06% ± 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% ± 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01).

Conclusions: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.

  • Lumbar plexus block
  • Posterior psoas compartment
  • Anterior 3-in-1
  • Mepivacaine
  • Minimum effective concentration
  • Anterior cruciate ligament repair

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Footnotes

  • Reprint requests: Gianluca Cappelleri, M.D., IRCCS Multimedica, Dept of Anesthesiology, Via Milanese 300-20090, Sesto San Giovanni, Milano, Italy. E-mail: gianluca.cappelleri{at}multimedica.it

  • Andrea Casati lost his life in a tragic accident on April 4, 2007. The coauthors share their memory of a good friend, a skilled anesthesiologist, and an esteemed researcher. We miss you very much.

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