The lumbar plexus is located between the quadrates lumborum and the psoas major muscles. The aim of this study was to evaluate the efficacy of a single 0.25% of enantiomeric excess levobupivacaine (S75:R25) injection through the psoas compartment blockage in postoperative analgesia of patients undergoing hip orthopedic surgery. As the second objective was evaluated the presence of analgesia of the feet was also evaluated to determine whether there was dissemination to the sciatic nerve, and length of pre-operative fasting, presence of thirst and hunger in the operating room entrance, and the ability to receive net carbohydrate (CHO) after recovery from spinal block in the PACU. Methods: One hundred patients received lumbar plexus blockage at the psoas compartment through nerve stimulator and a 0.25% enantiomeric excess levobupivacaine 40-ml injection. Analgesia and pain severity were evaluated at 4, 8, 12, 16, 20 and 24 hours after surgery, similarly to rescue opioids. Results: The ilioinguinal, genitofemoral, lateral cutaneous of the thigh, femoral and obturator were blocked in 92% of patients in the first 8 hours. Sciatic nerve block assessed by foot analgesia was observed in 15 patients at 4 hours and 12 patients at 8 hours. Sciatic nerve block disappeared in all patients after 12 hours. Blockage has reduced the amount of postoperative opioids, and 40% of patients required no additional postoperative analgesia, with analgesia duration of approximately 19 hours. There were no clinical signs or symptoms of bupivacaine toxicity, as well as no sequels secondary to nerves blockage. The mean fasting time was less than 3 hours. This reflected that no patient complied of thirst or hunger to reach the operating room. Conclusions: This report shows that injections into psoas compartment space is easy to perform and provides an effective blockage of the five nerves. The lumbar plexus blockage at the psoas compartment can be recommended for use in postoperative analgesia after hip orthopedic surgeries.
sufficient sedation to maintain the patient in position for posterior brachial plexus block and for the relief of pain in 55% of them during the procedure, without hemodynamic variation. 8 This prospective and observational study was performed to evaluate the clinical effectiveness of posterior brachial plexus access with a single injection of the combination of lidocaine and enantiomeric excess levobupivacaine with neurostimulator in patients undergoing clavicle, shoulder and proximal chair procedures of beach associated with general anesthesia. Methods The study was submitted and approved by the Ethics Research Committee (Number 05787/2014) and all patients were explained the method and obtained their consent by signing the informed consent form. The study was conducted between January 2015 to December 2018 with 50 patients of physical status I and II (ASA) of both sexes who underwent elective clavicle, shoulder and proximal humeral procedures in beach chairs associated with general anesthesia. The protocol was registered in the Brazil Platform (CAAE: 33373214.1.0000.5179). As part of Program ACERTO, all patients drank a single 200 mL liquid oral hypercaloric nutritional supplement (1.5 Kcal /mL) without residue, clarified and without addition of lipid and fiber (Fresubin Jucy®) about 2 to 4 hours before surgery. The sample size was based on the conservative calculation the population size of 95% and with a margin of error of 10%, obtaining the number of 50 patients, ages 18 to 60 years, weighing 60 to 80 kg, 160 to 180 cm tall. Exclusion criteria for posterior brachial plexus block were the presence of allergy to local anesthetics, bronchopulmonary disease, coagulopathy or neurological diseases with brachial plexus damage and emergency or classified surgery patients as class III or more of ASA physical state. All the blocks were performed using the landmarks as Figure 1.
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