No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Comparison between three in one femoral nerve block' and psoas compartment block for post-operative pain relief following lower limb surgical procedures
... Study done by S. Ponnambalam Namasivayam and his colleagues regarding LPB versus 3IN1B for post orthopedic surgery, lower limb pain management stated that both blocks were similar analgesic efficacy. The mean 1st analgesia request time was 9.10 (±1.52) in 3IN1B and 9.90 (±1.21) in LPB [27], which was similar to this study finding. ...
Introduction
Postoperative pain is the most common complaint in patients who underwent orthopedic surgery. Regarding with the severity of pain, orthopedic patients suffered more than non-orthopedic patients in the immediate post-operative period. Therefore, pain management is crucial for better patient outcome. Lumbar plexus (LB) and three -in-one (3IN1) nerve blocks have been routinely practiced as pain management techniques in the study area but the analgesic efficacy was not studied yet. Thus, this study was aimed to compare the analgesic efficacy of the LBP versus 3IN1B as postoperative pain management after thigh orthopedic surgery under spinal anesthesia.
Method
An institutional-based prospective cohort study was conducted from October 10, 2020 to March 30, 2021 at the University comprehensive specialized hospital. Non-probability convenient sampling was used to select participants in both groups. The time to first analgesic request, severity of pain and total analgesia consumption within the first postoperative 24 h were measured.
Result
The mean and standard deviation to seek the first analgesia request time was 11. 55 ± 2. 82hr and 13. 35 ± 2. 58hr (p- 0.07) in patients who received LPB and 3IN1B respectively. Pain severity at rest and on movement was also comparable. The total tramadol consumption was 67. 65 ± 27. 20 mg and 70. 59 ± 37. 19 mg (p- 0.71), while total Diclofenac consumption was 63. 23 ± 45. 74 mg and 44. 88 ± 34. 72 mg (p-0.07) in LPB and 3IN1B groups respectively.
Conclusion
The study showed that there was no significant difference in the time to first analgesia request, postoperative pain, both at rest and movement and total analgesic consumption, between the LPB and 3IN1B.
The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.
To compare the efficacy of a continuous posterior lumbar plexus (PSOAS) block to a continuous three-in-one femoral nerve (FEM) block in patients undergoing primary total knee replacement (TKR).
Sixty patients were randomly allocated to receive iv patient-controlled morphine analgesia (PCA), PCA plus a continuous FEM block with 30 mL ropivacaine 0.5% and epinephrine 1:200,000 bolus followed by an infusion of ropivacaine 0.2% at 12 mL.hr(-1) for 48 hr, or PCA plus a continuous PSOAS block with the same bolus and infusion regimen as the FEM group. Postoperative morphine consumption, verbal analogue scale pain scores at rest and during physiotherapy, and evidence of sensory and motor blockades were noted.
Both regional techniques significantly reduced 48 hr morphine consumption (FEM 37.3 +/- 34.7 mg, P = 0.0002; PSOAS 36.1 +/- 25.8 mg, P < 0.0001) compared to PCA (72.2 +/- 26.6 mg). Pain scores at rest, six and 24 hr after TKR were lower in the FEM and PSOAS groups compared to the PCA group (P < 0.0001). Although sensory and motor blockades of the obturator nerve were achieved more often in the PSOAS group than in the FEM group (P < 0.0001), morphine consumption and pain scores did not differ between the two groups.
Both continuous PSOAS block and continuous three-in-one FEM block provided better analgesia than PCA but no differences were seen between the two regional techniques.
Comment: The femoral 3-in-l nerve block has an impressive array of established indications. It has been administered to provide anesthesia for muscle biopsy, skin harvesting, and arthroscopy. It also can provide postoperative analgesia for knee joint surgery and for fractures of the femoral shaft. In 1973 when Winnie and colleagues' described their inguinal paravascular technique for lumbar plexus anesthesia (the "3-in-l block"), they believed their method simultaneously anesthetized the femoral, lateral femoral cutaneous, and obturator nerves with a single injection. Subsequent reports, however, have documented that complete anesthesia of the knee may not be provided by a combination of femoral 3-in-l and sciatic nerve blocks. Indeed, Cauhepe et al.2 demonstrated that contrast media injected into the femoral sheath tend to travel laterally, but proximal spread (toward the nerve roots) and medial spread (toward the obturator nerve at the pelvic brim) are limited. Winnie3 claims the observation that performance of a femoral 3-in-l nerve block does not affect the power of adduction can be explained on the basis of a differential conduction block of the obturator nerve. Aldiough it is possible that a sensory block of the obturator nerve could be attained through distal spread to the subsartorial plexus,4 completely sparing the motor fibers of the obturator nerve, such a hypodiesis has not been substantiated. This prospective observational study is both interesting and practical. The authors appreciate that further clinical and anatomic confirmation of thieir ob-
The objective of this study was to compare clinical and postoperative analgesic effects of femoral or psoas compartment blocks in patients undergoing arthroscopies.
Fifty patients were randomly assigned to one of the two groups. Either femoral (group F) or psoas compartment (group P) block was applied followed by sciatic nerve block. All nerve blocks were provided with a 15 ml of bupivacaine 0.5% + 10 ml of lignocaine (lidocaine) 2%. Systolic and diastolic blood pressure (SBP and DBP), heart rate, and pulse oxymetry (SpO2) were recorded. Quality of anaesthesia, time to first analgesic use, verbal pain scores (VPS), sensorial and motor blockade resolution times and side effects were also recorded.
Quality of anaesthesia, complete sensory blockade of obturator and lateral cutaneous nerves were higher in the group P than in group F. However, complete motor blockade findings were similar in both groups. In the group P, VPS values measured at 10 and 15 min were lower than that of group F. These values decreased at 10 min and thereafter as to baseline values. VPS values of the group F declined at 20 min and following measurement times as to baseline values. Durations of motor and sensorial block, and time to first analgesic use were similar between two groups. Total analgesic consumption at first 24 h in group P was lower than those of group F. Regarding heart rates, SpO2, SBP and DBP values, no significant differences were found between the groups.
Combined psoas–sciatic technique provided more comfortable intraoperative anaesthesia and better postoperative analgesia when compared with femoral–sciatic technique for arthroscopic procedures.
An atlas of regional anaesthesia. Lower extremity Anatomy. Local anaesthetics and Regional Anaesthesia Equipment
- L Brown David
Brown David L. An atlas of regional anaesthesia.
Lower extremity Anatomy. Local anaesthetics and
Regional Anaesthesia Equipment. 1992;2:3-11.
Postoperative analgesia with 3 in 1 femoral nerve block after prosthetic hip surgery
- R Fournier
- E Vangenel
- G Gaggero
- S Boccoui
- A Forester
- Z Gamulin
Fournier R, Vangenel E, Gaggero G, Boccoui S,
Forester A, Gamulin Z. Postoperative analgesia with
3 in 1 femoral nerve block after prosthetic hip
surgery. Canadian Journal of Anaesthesia
1998;45:34-8.
Postoperative analgesia with 3 in 1 femoral nerve block after prosthetic hip surgery
- R D Stevens
- E Van Gessel
- G Gaggero
Stevens RD, Van Gessel E, Gaggero G et al.
Postoperative analgesia with 3 in 1 femoral nerve
block after prosthetic hip surgery. Can J Anaesth
1998;45:34-48.
Postoperative analgesia after total hip arthroplasty. Comparison of I.V. patient controlled analgesia with morphine and single injection of femoral nerve (or) psoas compartment block. A prospective randomized double blinded study
- P Biboulet
- D Moran
- P Anbas
- Capdevillax Bringuir-Brancheren
Biboulet P, Moran D, Anbas P, Bringuir-Brancheren, Capdevillax. Postoperative analgesia
after total hip arthroplasty. Comparison of I.V.
patient controlled analgesia with morphine and
single injection of femoral nerve (or) psoas
compartment block. A prospective randomized
double blinded study. Reg. Anaesth. Pain Med
2004;29:102-9.
Comparison of femoral 3 in 1 block with spinal, epidural and general anaesthesia in outpatients
- C J Jankowski
Jankowski CJ. Comparison of femoral 3 in 1 block
with spinal, epidural and general anaesthesia in
outpatients, Anaesthesiology, 2000;93(1):115-21.