Ultrasound-guided lumbar plexus block through the acoustic window of the lumbar ultrasound trident

Karmakar, Manoj K.; Ho, A. M.-H.; Li, X.; Kwok, Wai‐Him; Tsang, Kenneth W.; Kee, Warwick D. Ngan

doi:10.1093/bja/aen026

Cited by 103 publications

(85 citation statements)

References 17 publications

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“…Recently, there has been an increase in interest in the use of ultrasound to guide peripheral nerve blocks [1][2][3]. We have observed during such procedures that musculoskeletal structures often appear significantly brighter and that there is loss of contrast between the nerve and its adjoining muscles in the elderly, which often makes it difficult to accurately delineate a peripheral nerve using ultrasound in this age group.…”

mentioning

confidence: 99%

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Karmakar²,

Lee³

et al. 2012

BJR

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Objectives: Musculoskeletal structures often appear brighter on imaging in the elderly, which makes it difficult to accurately delineate a peripheral nerve during ultrasound-guided regional anaesthetic procedures. The echo intensity of skeletal muscles is significantly increased in the elderly. However, there are no data comparing the echo intensity of peripheral nerves in the young and the elderly, which this study was designed to evaluate. Methods: 13 healthy, young volunteers (aged ,30 years) and 11 elderly patients (aged .60 years) who were scheduled to undergo orthopaedic lower limb surgery were recruited. The settings of the ultrasound system were standardised and a high-frequency linear array transducer was used for the scan. A transverse scan of the median nerve (MN) and the flexor muscles (FMs) at the left mid-forearm was performed and three video loops of the ultrasound scan were recorded for each subject. Still images were captured from the video loops and normalised. Computer-assisted greyscale analysis was then performed on these images to determine the echo intensity of the MN and the FMs of the forearm. Results: The echo intensity of the MN and FMs of the mid-forearm was significantly increased in the elderly (p,0.005). There was also a reduction in contrast between the MN and the adjoining FM in the elderly (p50.04). Conclusion: Under the conditions of this study, the MN and the FMs in the forearm appeared significantly brighter than those in the young, and there was a loss of contrast between these structures in sonograms of the elderly.

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mentioning

confidence: 99%

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Karmakar²,

Lee³

et al. 2012

BJR

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“…Above all for lumbar plexus block, this could translate into higher success rates and reduced needle-related complications [21].…”

Section: Discussionmentioning

confidence: 99%

The Comparing of Ultrasound-guided Techniques: Sciatic Block with Continuous Lumbar Plexus Block or Continuous Femoral Nerve Block for Anesthesia and Analgesia of Total knee Replacement

Dauri¹,

Faria²,

Celidonio³

et al. 2013

TOATJ

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Background and Aims: This double blind prospective randomized clinical trial evaluated the efficacy and safety of continuous ultrasound-guided lumbar plexus block compared to continuous ultrasound-guided femoral nerve block, in the intra-operative and postoperative periods after total knee replacement.Methods: Forty ASA I-III patients were randomized to receive: continuous femoral block (n= 20, 30 ml of ropivacaine 5 mg/ml) or continuous lumbar plexus block (n= 20, 30 ml of ropivacaine 5 mg/ml) both in association with single injection sciatic nerve block. All patients received continuous infusion of 2 mg/ml of ropivacaine at 8 ml/h for 48 hours and intravenous morphine for patient-controlled analgesia. Primary outcomes were intra-operative sufentanil consumption and verbal analogue scale (VAS) score at rest at 24h follow up.

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“…Anesthetic technique was balanced general anesthesia (BGA) or spinal block (SB) with 0.5% isobaric bupivacaine or 0.5% isobaric levobupivacaine. Approach and catheter introduction technique for cLPB was that described by Capdevila et al 4 with dual guidance (electric stimulation and ultrasound 6 ). After catheter insertion, 20mL of 0.5% ropivacaine were administered.…”

Section: Methodsmentioning

confidence: 99%

Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

Costa¹,

Carvalho²,

Castro³

et al. 2016

Revista Dor

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BACKGROUND AND OBJECTIVES:Postoperative pain after total hip arthroplasty is moderate to severe and requires effective analgesic techniques. This study aimed at comparing continuous lumbar plexus block and epidural analgesia in patients submitted to hip arthroplasty. METHODS: This is a prospective, observational and analytical study of patients submitted to hip arthroplasty in a two-year period, under postoperative analgesia with continuous lumbar plexus block and epidural analgesia. Patients were divided according to the analgesic technique chosen by the anesthesiologist. The protocol consists in continuous perfusion of 0.2% ropivacaine (5mL/h) via continuous lumbar plexus block catheter or 0.1% ropivacaine and fentanyl (3µg/mL) (5mL/h) via epidural catheter. Using Acute Pain Unit records, three postoperative days were compared between continuous lumbar plexus block and epidural analgesia with regard to pain intensity, rescue analgesia, complications and hospital stay. RESULTS: Participated in the study 162 patients. Most patients of both groups had no pain in the first postoperative day (77.6% continuous lumbar plexus block versus 79.2% epidural). Both groups were not different with regard to pain intensity and need for rescue analgesia (23.5% continuous lumbar plexus block versus 22.1% epidural). Continuous lumbar plexus block group had fewer complications (4.7% versus 23.4%), namely motor block, nausea, vomiting and itching. The low number of complications does not allow the detection of significant differences between techniques. Most patients of both groups were discharged in the third postoperative day. Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

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Ultrasound-guided lumbar plexus block through the acoustic window of the lumbar ultrasound trident

Cited by 103 publications

References 17 publications

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

Quantitative evaluation of the echo intensity of the median nerve and flexor muscles of the forearm in the young and the elderly

The Comparing of Ultrasound-guided Techniques: Sciatic Block with Continuous Lumbar Plexus Block or Continuous Femoral Nerve Block for Anesthesia and Analgesia of Total knee Replacement

Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

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