In with the New, Out with the Old? Comparison of Two Approaches for Psoas Compartment Block

Abstract

We compared the approaches of Winnie and Capdevila for psoas compartment block (PCB) performed by a single operator in terms of contralateral spread, lumbar plexus blockade, and postoperative analgesic efficacy. Sixty patients underwent PCB (0.4 mL/kg levobupivacaine 0.5%) and subsequent spinal anesthesia for primary joint arthroplasty (hip or knee) in a prospective, double-blind study. Patients were randomly allocated to undergo PCB by using the Capdevila (group C; n = 30) or a modified Winnie (group W; n = 30) approach. Contralateral spread and lumbar plexus blockade were assessed 15, 30, and 45 min after PCB. Contralateral spread (bilateral from T4 to S5) and femoral and lateral cutaneous nerve block were evaluated by sensory testing, and obturator motor block was assessed. Bilateral anesthesia occurred in 10 patients in group C and 12 patients in group W (P = 0.8). Blockade of the femoral, lateral cutaneous, and obturator nerves was 90%, 93%, and 80%, respectively, for group C and 93%, 97%, and 90%, respectively, for group W (P > 0.05). No differences were found in PCB procedure time, pain scores, 24-h morphine consumption, or time to first morphine analgesia.

Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy

“…Regional anesthetic techniques such as sciatic, femoral, or psoas compartment block may cause insufficient anesthesia of varying degrees; therefore, an inflated tourniquet may cause severe pain in some patients who are receiving inadequate anesthesia. Contralateral extension of the psoas compartment block is between 4% and 40% [26,27]. The reason for the absence of sensory or motor block in our study at the contralateral extremity was most probably due to examination of the knee area only in our study.…”

Postoperative analgesia for hip arthroscopy: combined L1 and L2 paravertebral blocks

“…Because the psoas compartment appears to communicate with the lumbar paravertebral space, it is not surprising that a largevolume injectate may produce an extensive PVB with the risk of extension into the epidural space or contralateral spread via the prevertebral fascia. Mannion et al [7] reported epidural spread in one third or more of patients using either of two different approaches to psoas compartment block. However, as other reports [8,9] have shown, it would have been impossible for these authors to know which of their blocks was actually in the psoas compartment versus within the psoas sheath.…”

Is L2 Paravertebral Block Comparable to Lumbar Plexus Block for Postoperative Analgesia After Total Hip Arthroplasty?

“…LPB-induced muscle weakness has several possible explanations. First, LPB may be associated with variable distribution of the local anesthetic [7,9,13]. Second, having sought a motor end point (quadriceps twitch) for needle placement, perhaps the technique is biased toward localization and blockade of these motor fibers.…”