Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly

Parasacral approach to block the sciatic nerve: A 400-case survey

“…[2][3][4][5] The mean time to perform the block and average onset time are also similar to other approaches to the sciatic nerve. 4,[10][11][12] The fact that sensory and motor block occurred almost at the same time for both common peroneal and tibial components is relatively unusual compared with results of other sciatic nerve approaches that use a single injection.…”

“…This block appears to be efficacious, easy to perform, and an easily acquired skill. [2][3][4][5] Because it is more efficient than the conventional Labat-Winnie gluteal approach, 3 PS has become the standard approach for sciatic nerve block in some institutions. Nevertheless, the published experience is limited, thus far, to a total of 155 cases.…”

“…Nevertheless, the published experience is limited, thus far, to a total of 155 cases. [2][3][4][5] The aim of the present study was to prospectively assess PS block in a larger group of consecutive patients.…”

Is neuraxial blockade contraindicated in the patient with aortic stenosis?

“…14 For hip surgery, a lumbar plexus block of the femoral, lateral femoral cutaneous, and obturator nerves combined with a sciatic nerve block should provide sufficient anesthesia for hip surgery. 46,47 Furthermore, a lumbar plexus catheter could be used for postoperative pain control. In general, peripheral nerve block offers more hemodynamic stability than a neuraxial block, but again with the caveat that stability is not guaranteed.…”

“…46,48 One study showed a drop in blood pressure during lumbar plexus plus sciatic block to be about 28% from baseline versus 38% with spinal anesthesia. 47 Compared with CSA, lumbar plexus plus sciatic nerve block combination is more time and labor intensive and carries the risk of local anesthetic toxicity but is a viable alternative if attention is paid to the possibility of contralateral spread.…”