Article

Approaches to the lumbar plexus: success, risks, and outcome.

Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Regional Anesthesia and Pain Medicine (impact factor: 4.08). 30(2):150-62. pp.150-62
Source: PubMed
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    Article: Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery.
    Marcel A de Leeuw, Cornelis Slagt, Martijn Hoeksema, Wouter W A Zuurmond, Roberto S G M Perez
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    ABSTRACT: Hemodynamic variables can theoretically be influenced by a combined psoas compartment-sciatic nerve block (CPCSNB) owing to a relatively high systemic absorption of local anesthetics and extended vasodilatation in the anesthetized limb (hemisympatectomy). In this study we assessed and documented hemodynamic changes during CPCSNB for elective orthopedic surgery. Twenty consecutive patients scheduled for a total hip arthroplasty revision surgery were subjected to a CPCSNB with 150 mg bupivacaine (with epinephrine 1:200.000) 90 minutes before surgery (2 separate single-injection blocks: 30 mg bupivacaine for the sciatic nerve block and 120 mg bupivacaine for the psoas compartment block). Cardiac index, invasive arterial blood pressure, and heart rate were measured at baseline and 60 minutes after puncture using a minimally invasive cardiac output monitoring device (FloTrac/Vigileo™ system (Edwards Lifesciences, Irvine, CA)). Cardiac index did not change after a CPCSNB (preblock cardiac index 2.98 ± 0.54 l · min(-1) · m(-2) versus postblock cardiac index 2.99 ± 0.60 l · min(-1) · m(-2)). There was a significant reduction in mean arterial blood pressure (108 ± 16 mm|Hg vs. 99 ± 16 mm|Hg (P < 0.001)) and diastolic blood pressure (75 ± 9 mm|Hg vs. 68 ± 10 mm|Hg (P = 0.001)). Heart rate increased significantly (68 ± 9 beats · min(-1) vs. 73 ± 10 beats · min(-1) (P = 0.001)). CPCSNB did not affect cardiac index. Changes in arterial blood pressure and heart rate, although statistically significant, remained within an acceptable clinical range (<10% variation). CPCSNB does not appear to induce clinically significant hemodynamic changes in this group of patients.
    Anesthesia and analgesia 12/2010; 112(3):719-24. · 3.08 Impact Factor
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    Article: The psoas compartment block for hip surgery: the past, present, and future.
    M A de Leeuw, W W A Zuurmond, R S G M Perez
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    ABSTRACT: A posterior lumbar plexus block or psoas compartment block (PCB) is an effective locoregional anesthetic technique for analgesia and anesthesia of the entire lower extremity including the hip. Since the first description in the early seventies, this technique has been modified based on advanced knowledge of the anatomical localization of the lumbar plexus and the improvement of technical equipment. This paper provides an overview of the history, clinical efficacy, and risk profile of the PCB focused on hip surgery. Current status and future expectations are discussed.
    Anesthesiology Research and Practice 01/2011; 2011:159541.
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