One operator’s experience of ultrasound guided lumbar plexus block for paediatric hip surgery

Abstract

Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing hip surgery for congenital hip dislocation. After obtaining local institutional ethical committee approval and parental informed consent, ASA I or II, 1-6 years old children undergoing hip surgery were included into the study. Lumbar plexus block was performed after general anaesthesia using ultrasound guided Shamrock Method. Bupivacaine 0.25 % was used during block performance. Dose of the local anaesthetic was 1 ml/kg and the maximum dose was limited to 20 ml. In the postoperative period pain was assessed using modified CHEOPS (Children's Hospital Eastern Ontario Pain Scale) pain score. If pain score in the postoperative period exceeded 3, patients received IV paracetamol 15 mg/kg. Morphine 0.1 mg/kg IV was planned to administer if pain scores were still higher than 3 despite paracetamol treatment. 75 patients whose mean age was 47 months were enrolled into the study. All blocks were performed successfully and without complications. Mean time for the first analgesic is found as 10 h after surgery. Only one patient required morphine in the recovery unit and 23 patients received paracetamol. US guided lumbar plexus block using Shamrock Method is an effective technique for providing postoperative analgesia after hip surgeries in children and it's effect lasts for 8-12 h after surgery.

Continuous Lumbar Plexus Block under the Guidance of the “Shamrock Method” Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients

“…Ultrasound-guided positioning has obvious advantages over nerve stimulator positioning. Under ultrasound guidance, the relationship between the needle and nerves as well as the surrounding vascular tissues can be directly observed and the success rate of block is improved, thus reducing the occurrence of complications such as kidney and nerve damage [ 6 , 7 ]. In this study, the “Shamrock method” was used to guide continuous lumbar plexus block and continuous femoral nerve block and to compare the analgesic effects and hemodynamic effects of the two ways on elderly patients after TKA.…”

Comparative efficacy analysis of ultrasound-guided quadratus lumborum block and lumbar plexus block in hip arthroscopy: a pilot prospective randomized controlled trial

“…Studies by Gürkan et al. showed that the shamrock approach could prolong the analgesic time after hip surgery [ 24 ].…”

Ultrasound‐guided lumbar plexus block in children and adolescents using a transverse lumbar paravertebral sonogram: Initial experience

“…With this approach, satisfactory sensory changes were achieved in a high percentage of patients. Gurkan used this technique on children 1‐6 years of age having open surgery for congenital hip dislocation and reports block duration of 8‐12 hours and only one patient requiring morphine.…”

“…With this approach, satisfactory sensory changes were achieved in a high percentage of patients. Gurkan 16 | 293 of the block under general anesthesia. We report no serious complications in our study, but the study was not powered to detect complications.…”