Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

Abstract

BackgroundAnesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block.Case presentationFour patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations.ConclusionsThe combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture

“…[ 8 ] The lateral femoral cutaneous nerve (LFCN) from the lumbar plexus (L2–L3), lateral cutaneous branch of iliohypogastric nerve (T12 and L1) and subcostal nerve (T12 thoracic nerve) innervate the area of the superior lateral gluteal region and the proximal lateral thigh that are involved in skin incision of posterolateral approach to hip joint. [ 8 9 ] Surgical anaesthesia can be achieved with the blockage of all branches of the lumbar and sacral plexuses.…”

“…Furthermore, LPB is reported to be insufficient when used alone for hip surgeries, as these procedures require sensorial block between T12 and L1 and also sacral plexus. [ 9 ]…”

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

“…Ultrasound guide plus nerve stimulator makes thorough nerve blocks possible for THA. 28,29 Compared to general anesthesia and neuraxial anesthesia, nerve blocks tampered less of physiology. Moreover, the complications related to extubation, emergence in PACU and catheter are avoided.…”

Ultrasound-guided lumbar selective nerve root block plus T12 paravertebral and sacral plexus block for hip and knee arthroplasty

“…For analgesia requirement of skin incision of posterolateral approach to hip surgery, it was necessary to block the lateral femoral cutaneous nerve from the lumbar plexus (L2–3), lateral cutaneous branch of iliohypogastric nerve (T12 and L1), and subcostal nerve (T12 thoracic nerve). [8] For knee arthroplasty, the primary relevant target nerves were femoral, obturator, sciatic, and lateral femoral cutaneous. [9] To relieve the uncomfortable stress of application of tourniquet, T12 paravertebral block also was necessary.…”

“…In previous studies, additional large amount of propofol and infiltration to the incision were used as the supplement, and a large amount of local anesthetic was required to obtain an effective block. [8] In the cases we reported here, we performed multiple selective nerve blocks which satisfied the required of surgery but used much less amount of local anesthetic.…”