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Regional Anesthesia and Acute Pain: Original Article
Psoas Versus Femoral Blocks: A Registry Analysis of Risks and Benefits
  1. Hagen Bomberg, MD*,
  2. Andrea Huth, MS*,
  3. Stefan Wagenpfeil, PhD†,
  4. Paul Kessler, MD‡,
  5. Hinnerk Wulf, MD§,
  6. Thomas Standl, MD∥,
  7. André Gottschalk, MD**,
  8. Jens Döffert, MD††,
  9. Werner Hering, MD‡‡,
  10. Jürgen Birnbaum, MD§§,
  11. Claudia Spies, MD§§,
  12. Bernd Kutter, MD∥∥,
  13. Jörg Winckelmann, MD∥∥,
  14. Gerald Burgard, MD***,
  15. Oliver Vicent, MD†††,
  16. Thea Koch, MD†††,
  17. Daniel I. Sessler, MD‡‡‡,
  18. Thomas Volk, MD* and
  19. Alexander Raddatz, MD*
  1. *Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, and †Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Center, Homburg/Saar; ‡Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University, Hospital, Frankfurt; §Department of Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg; ∥Department of Anesthesia, Intensive and Palliative Care Medicine, Solingen Academic Hospital of the University of Cologne, Solingen; **Department of Anesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hospital, Hannover; ††Department of Anesthesiology and Intensive Care Medicine, Hospital Calw-Nagold, Nagold; ‡‡Department of Anesthesiology, St Marien-Hospital, Siegen; §§Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine, Berlin; ∥∥Department of Anesthesiology, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm; ***Department of Anesthesiology, Intensive Care and Pain Therapy, HELIOS Hospital Erfurt, Erfurt; †††Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital, Dresden, Germany; and ‡‡‡Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
  1. correspondence: Hagen Bomberg, MD, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany (e-mail: Hagen.Bomberg{at}uniklinikum-saarland.de).

Abstract

Background and Objectives Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections.

Methods We extracted 22,434 surgical cases from the German Network for Regional Anesthesia registry (2007–2014) and grouped cases as psoas (n = 7593) and femoral (n = 14,841) blocks. Insertion-related complications (including single-shot blocks and catheter) and infectious complications (including only catheter) in each group were compared with χ2 tests. The groups were compared with multivariable logistic models, adjusted for potential confounding factors.

Results After adjustment for potential confounding factors, psoas blocks were associated with more complications than femoral blocks including vascular puncture 6.3% versus 1.1%, with an adjusted odds ratio (aOR) of 3.6 (95% confidence interval [CI], 2.9–4.6; P < 0.001), and multiple skin punctures 12.6% versus 7.7%, with an aOR of 2.6 (95% CI, 2.1–3.3; P <0.001). Psoas blocks were also associated with fewer catheter-related infections: 0.3% versus 0.9% (aOR of 0.4; 95% CI, 0.2-0.8; P = 0.016), and with improved patient satisfaction (mean ± SD 0- to 10-point scale score, 9.6 ± 1.2 vs 8.4 ± 2.9; P < 0.001). Results from a propensity-matched sensitivity analysis were similar.

Conclusions Psoas blocks are associated with more insertion-related complications but fewer infectious complications.

Clinical Trial Registration ID NCT02846610.

https://doi.org/10.1097/AAP.0000000000000643

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    Footnotes

    • This analysis was supported by institutional funds. The German Network for Regional Anesthesia was supported by the German Society of Anesthesiology and Intensive Care Medicine, the Association of German Anesthesiologists, and the German Research Foundation.

      The authors declare no conflict of interest.