A Clinical Comparison of Psoas Compartment and Inguinal Paravascular Blocks Combined with Sciatic Nerve Block

Abstract

The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.

A review of approaches and techniques for lower extremity nerve blocks

“…7,10,12 Two RCTs have reported a higher success rate for blockade of the lateral femoral cutaneous nerve with the posterior approach (90-97 vs 50-53%; P < 0.05) 10,12 whereas another study found no difference (85-95%). 7 All four RCTs reported significantly better obturator block with the posterior approach: three RCTs noted an improved sensory block (77-80 vs 47-50%; P < 0.05) [10][11][12] while two studies also found a higher rate of motor block (63-100 vs 0-30%; P < 0.05). 7,10 However, in 45 patients undergoing total hip replacement, one study compared single shot lumbar plexus and 3-in-1 blocks and failed to detect any difference in nerve block distribution.…”

“…7 All four RCTs reported significantly better obturator block with the posterior approach: three RCTs noted an improved sensory block (77-80 vs 47-50%; P < 0.05) [10][11][12] while two studies also found a higher rate of motor block (63-100 vs 0-30%; P < 0.05). 7,10 However, in 45 patients undergoing total hip replacement, one study compared single shot lumbar plexus and 3-in-1 blocks and failed to detect any difference in nerve block distribution. 13 Two RCTs (combined n = 119) have compared continuous posterior and anterior approaches for patients undergoing total knee replacement.…”

La neurostimulation n’augmente pas le taux de succès du bloc du nerf saphène

“…Le suivi des patients à distance n'a montré aucune complication clinique neurologique locale à type de paresthésie, dysesthésie ou faiblesse musculaire. D Di is sc cu us ss si io on n Si de nombreux auteurs ont étudié le taux d'échec des blocs périphériques et en particulier du bloc fémoral selon différentes techniques de ponction, [14][15][16] seulement deux études se sont intéressées au taux d'échec sur le nerf saphène lors de la réalisation d'un bloc fémoral, que ce soit avec recherche de paresthésie ou à l'aide d'un neurostimulateur avec respectivement 23 % et 16 % d'échec. 3,11 Le taux d'échec global de 20 % de notre étude confirme les résultats de Bouaziz et coll.…”

Comparison between &#145;three in one femoral nerve block' and psoas compartment block for post-operative pain relief following lower limb surgical procedures

“…Some investigators have questioned its efficacy due to incomplete block of obturator nerve. 1,2 Failure to achieve block of this nerve may cause incomplete analgesia after hip surgery. better analgesia after hip operation.…”

“…better analgesia after hip operation. 2 The present study was done to compare the efficacy of "3 in 1"block versus psoas compartmental block in relieving post-operative pain for orthopedic procedures in hip, femur and knee surgeries.…”