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199 Less invasive, more effective: single puncture combined lumbar plexus and transmuscular quadratus lumborum blocks for long lasting unilateral vascular surgery procedures in fragile patients
  1. A Strumia,
  2. M Bernardinetti,
  3. F Costa,
  4. G Pascarella,
  5. E Tomaselli,
  6. S Rizzo,
  7. LM Remore,
  8. F Spinelli and
  9. FE Agro
  1. Campus Bio Medico University of Rome, Rome, Italy


Background and Aims Peripheral vascular surgery patients commonly present multiple diseases and receive anticoagulants or antiplatelet drugs. Nonetheless, revascularization procedures may last many hours. Thus the risk of a long-lasting general anesthesia may increase while neuraxial blocks may expose patients to an augmented risk of bleeding [1]. Peripheral blocks last longer and guarantee hemodynamic control but may not be adequate for procedures involving the iliac artery.

We present a case of a patient, who underwent revision of an iliac-femoral bypass under a combination of lumbar plexus and quadratus lumborum blocks.

Methods Female 70 y.o., ASA III. Chronic legs ischemia, diabetes, multiple bypass and left toe amputation, hypertension, blindness, ischemic cardiopathy, moderate aorta stenosis. Scheduled for revision of iliac-femoral bypass of the left leg. expected to last 3 to 6 hours.General anaesthesia and neuraxial anaesthesia weren’t the best options, due to patient multimorbidity and aorta’s stenosis.With patient’s consent, we performed an ultrasound plus nerve stimulation guided lumbar plexus block with Shamrock approach [2] (Stimuplex ultra 360 – 100 mm – Bbraun) with 30 m of 0,375% ropivacaine; subsequently the needle was retracted and further 20 ml of the same mixture were deposited in the plane between psoas and quadratus lomborum muscles. Weak sedation with propofol TCI 0,6 µg/ml was administered.

Results Surgery was carried out in 4 hours with complete surgical anesthesia and hemodynamic stability. After one hour in recovery room, patient was dismissed to the ward.

Conclusions Shamrock approach allowed the successful combination of lumbar plexus and transmuscular quadratus lomborum block

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