Ultrasound-guided psoas compartment block and general anesthesia for arthroscopic knee surgery: a case report

Abstract

Anesthetizing the lumbar plexus at its origin facilitates a more "complete" psoas compartment block compared to peripheral approaches. It is usually performed using surface anatomical landmarks, and the site for local anesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. Ultrasound may provide guidance alone or together with the aid of nerve stimulation during nerve blocks. We present a 48-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, who refused spinal anesthesia, and underwent knee arthroscopy with ultrasound-guided psoas compartment block and general anesthesia. Following the standard monitoring and lateral decubitus positioning, the vertebral body, psoas, erector spinae, and quadratus lumborum muscles and hyperechoic nerve roots of the patient were visualized at the level of L4-5 with curvilinear ultrasound probe. The needle was inserted with ultrasound guidance, and correct tip position was confirmed with quadriceps contraction. Then, the mixture of 30 mL local anesthetic (10 mL 2% lidocaine and 20 ml 5% levobupivacaine) was injected at the estimated position of the lumbar plexus (junction of the posterior third and anterior two-thirds of the psoas muscle). He also received general anesthesia for the surgery. Anesthesia and surgical procedures were completed successfully without any additional anesthetic/analgesic requirement or complication. The postoperative period was pain-free both at rest and during mobilization for 24 hours. This case report shows that ultrasound-guided psoas compartment block is feasible and efficient for peri- and postoperative analgesia during knee arthroscopy.

Changing trends and regional anesthesia practices in Turkey

“…[31] Öte yanda psoas kompartman bloğu gibi sinirlerin net olarak görüntülenemediği derin bloklarda, ya da görüntü kalitesindeki sorunlar nedeni ile siyatik sinir bloklarında NS ile doğrulama yapılması klinik olarak yararlı olabilir. [32] Eğitim amacı ile de NS ve US yine birlikte kullanılması yararlı olacaktır. İntra-nöral enjeksiyonun değerlendirilmesi açısından ise NS yardımı ile elde edilen bilgi klinik açıdan değer-lidir.…”

Use of ultrasound for lower extremity

“…Very few studies have been published regarding the application of the ultrasound guidance for the psoas compartment block in adults [19]. Sonoanatomical studies have shown that it is possible to visualize the transverse processes, vertebral body, psoas major muscle, erector spinae, quadratus lumborum, lower pole of the kidney, peritoneum, aorta, and vena cava [20,21], whereas direct imaging of the nerve roots is not easy to reproduce because of their depth and the 'acoustic shadow' of the transverse processes [22 & ].…”