Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture

Abstract

Femur neck fractures may occur in elderly patients with multiple co-morbidities. Spinal or general anaesthesia may not be safe in such patients, leading to a search for other safer alternatives. Herein, we report a case in which a never previously reported combination of quadratus lumborum block (QLB) and erector spinae plane block (ESPB) was successfully used as the main anaesthetic method for hemiarthroplasty. An 86-year-old female patient with severe aortic stenosis was scheduled for internal fixation or hemiarthroplasty due to right femoral neck fracture. Following sedoanalgesia, the patient was placed in lateral decubitis position and ESPB and transmuscular QLB were performed from the fourth lumbar vertebra level. Adequate and effective surgical anaesthesia was achieved and hemiarthroplasty was performed. The combination of lumbar ESPB and QLB can be used for the anaesthesia management in high-risk patients undergoing hemiarthroplasty.

<p>Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block</p>

“…Only a few case reports have reported sensorial findings after lumbar ESPB. 8,17,23,25,28,30,[35][36][37][38][39][40][41][42][43][44][45][46][47] Spread of LA between T12 and S1 dermatomes were reported when 30-40 mL of LA was used, 28 with similar findings for the lower volume of 20 mL also reported. 30,38 Low volume injections have generally been utilized in back pain and spinal surgeries.…”

“…8,29 The first use of lumbar ESPB and transmuscular QLB as the main anesthetic method was reported in a high-risk patient undergoing surgery for femur neck fracture. 37 In this case report, 40 mL LA and 20 mL of LA were used for ESBP and QLB, respectively. Surgery was completed successfully with minimal dose opioids and ketamine without the need for general anesthesia.…”

The erector spinae plane block: a narrative review

“…Other authors have shown its effectiveness as a second line therapy after the unsuccessful insertion of an epidural catheter [41] or its failure [49,51]. Additionally, it has been reported to successfully induce anesthesia in patients with a high risk of adverse effects from general anesthesia [30,31,85,86,99]. However, more randomized controlled trials are necessary to establish the best indications of ESP block as an analgesic technique, in chronic, acute, and postoperative pain.…”

Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports

“…We hypothesized that the combined use of QLB and ESPB could increase the probability and range of the effect by devising the puncture site. A previous case report on the combined use of ESPB and QLB for hip surgery highlighted the importance of their mutual increase in effectiveness and complementing each other's missing aspects [15]. In the present cases, both patients weighed over 50 kg.…”