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

Abstract

Rationale: For hip or knee arthroplasty, it is essential to develop a satisfied peripheral nerve block method that will benefit elderly patients or patients who are contraindicated to neuraxial anesthesia. Patients concerns: Patient in Case 1 suffered from the right intertrochanteric fracture, combined with chronic obstructive pulmonary disease; Patient in Case 2 suffered from hip osteoarthritis; combined with ankylosing spondylitis; Patient in Case 3 suffered from rheumatoid arthritis, combined with ischemic encephalopathy. Diagnosis: Case 1: Right intertrochanteric fracture, chronic obstructive pulmonary disease. Case 2: hip osteoarthritis. Case 3: rheumatoid arthritis. Interventions: Ultrasound-guided lumbar selective nerve root block (SNRB) plus T12 paravertebral and sacral plexus block were performed in 2 patients who received hip arthroplasty and 1 patient who received knee arthroplasty. Outcomes: All patients successfully received surgeries with this peripheral nerve block method and no postoperative complication was reported. Lessons: Ultrasound-guided lumbar SNRB plus T12 paravertebral and sacral plexus block not only satisfied the analgesia requirement of surgery, but also reduced the consumption of local anesthetic.

Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review

“…This narrative review included all published materials illustrating technical aspects of lumbar USTFI. Lumbar selective nerve block (SNRB), performed as a diagnostic procedure for nerve root pain with similar technical procedure as that of TFIs, was also included [19][20][21][22][23]. PubMed, Embase, and EBSCO were searched for relevant literature using combinations of keywords, such as US, USguided, sonography, lumbar, TFI, periradicular injection, pararadicular injection, and selective nerve root block.…”

“…In both studies, the needle tip confirmation was through contrast and fluoroscopy. Mei et al [23] in 2019 described USguided SNRB with the same technique in patients posted for knee or hip replacement. Nevertheless, the needle tip was checked with fluoroscopy without dye.…”

“…The combined approach of USTFI is described only in humans [18]. All studies on US-guided SNRB were on humans [19][20][21][22][23]. Implication: Although cadaver studies are marvelous in exploring a new technical approach, its validation requires human studies.…”

“…Of the seven articles and one case report published on lumbar USTFI, three articles described axial orientation, four articles and one case report described PS orientation, and one study described combination of axial and PS orientations of US probe [11][12][13][14][15][16][17][18]. In US-guided SNRB, three and two studies utilized transverse and PS orientation, respectively [19][20][21][22][23]. Implication: The authors have explored both axial and PS approaches for USTFI.…”

“…In all the studies except one, a curvilinear probe was used [11][12][13][14][15][16][17][19][20][21][22][23]. All patients included by Yang et al [18], who used the linear probe, were of low BMI.…”