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Ultrasound-Guided Lumbar Plexus Block Using a Transverse Scan Through the Lumbar Intertransverse Space: A Prospective Case Series
  1. Manoj Kumar Karmakar, MD, FRCA, FHKCA, FHKAM*,
  2. Jia Wei Li, PhD*,
  3. Wing Hong Kwok, FANZCA* and
  4. Admir Hadzic, MD
  1. *Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Special Administrative Region (SAR), People’s Republic of China
  2. The New York School of Regional Anesthesia, New York, NY
  1. Address correspondence to: Manoj Kumar Karmakar, MD, Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, 4th Floor, Main Clinical Block and Trauma Centre, 32 Ngan Shing Street, Shatin, New Territories, Hong Kong (e-mail: karmakar{at}cuhk.edu.hk).

Abstract

Background and Objectives 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.

Methods 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/m2 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.

Results 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/m2), 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.

Conclusion Ultrasound-guided LPBs can be reliably accomplished using the PMTS.

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Footnotes

  • The authors declare no conflict of interest.

    The anatomical section in Figure 2 is courtesy of the Visible Human Server at EPLF (Ecole Polytechnique Fédérale de Lausanne), Visible Human Visualization Software, http://visiblehuman.epfl.ch, and Gold Standard Multimedia, www.gsm.org. All illustrations and sonograms are reproduced with permission from www.aic.cuhk.edu.hk/usgraweb.

    This work should be attributed to the Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR, People’s Republic of China.

    This work was locally funded by the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, People’s Republic of China.

    This work was presented at the International Symposium on Spine and Paravertebral Sonography for Anesthesia and Pain Medicine, 2013, April 5 to 7, 2013, Hong Kong, SAR, China.

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