The Inguinal Paravascular Technic of Lumbar Plexus Anesthesia

Winnie, Alon P.; Ramamurthy, Somayaji; Durrani, Zia

doi:10.1213/00000539-197311000-00036

Cited by 366 publications

(220 citation statements)

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“…[5][6][7][8] Alternately Winnie et al 9 have suggested that an inguinal, paravascular injection in the femoral perineural sheath (with concomittant distal manual compression and cephalad angulation of the needle) will lead to retrograde LA migration towards the lumbar plexus. Since the three main terminal branches (femoral, lateral femoral cutaneous and obturator nerves) of the lumbar plexus can be anesthetized with a single injection, this anterior approach is also called "3-in-1 block".…”

Section: Approachesmentioning

confidence: 99%

“…In their original description of the anterior approach, Winnie et al 9 advocated using paresthesiae to locate the femoral nerve. Seven subsequent RCTs have proposed modifications to this technique.…”

Section: Techniquesmentioning

confidence: 99%

“…Despite similar blockade of the femoral and lateral femoral cutaneous nerves, the 3-in-1 technique produced a better sensory block of the obturator nerve at one, 24 and 48 hr. 22 In 2006, using Winnie's technique, 9 Pham Dang et al 23 investigated the role of femoral perineural sheath expansion for the insertion of stimulating catheters. In 60 patients randomly allocated to a bolus of 10 mL D5W through the needle or no bolus, they found that sheath expansion reduced the number of attempts (P = 0.007) and the resistance encountered (P = 0.01) during successful perineural catheter placement.…”

Section: Techniquesmentioning

confidence: 99%

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Un bilan des approches et techniques pour les blocs nerveux du membre inférieur

Tran

Clemente

Finlayson

2007

Can J Anesth/J Can Anesth

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Purpose: The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding approaches and techniques for lower extremity nerve blocks.Source: Using the MEDLINE (January 1966 to April 2007 and EMBASE (January 1980 to April 2007 databases, medical subject heading (MeSH) terms "lumbosacral plexus", "femoral nerve", "obturator nerve", "saphenous nerve", "sciatic nerve", "peroneal nerve" and "tibial nerve" were searched and combined with the MESH term "nerve block" using the operator "and". Keywords "lumbar plexus", "psoas compartment", "psoas sheath", "sacral plexus", "fascia iliaca", "three-in-one", "3-in-1", "lateral femoral cutaneous", "posterior femoral cutaneous", "ankle" and "ankle block" were also queried and combined with the MESH term "nerve block". The search was limited to RCTs involving human subjects and published in the English language. Forty-six RCTs were identified. Principal findings:Compared to its anterior counterpart (3-in-1 block), the posterior approach to the lumbar plexus is more reliable when anesthesia of the obturator nerve is required. The fascia iliaca compartment block may also represent a better alternative than the 3-in-1 block because of improved efficacy and efficiency (quicker performance time, lower cost). For blockade of the sciatic nerve, the classic transgluteal approach constitutes a reliable method. Due to a potentially shorter time for sciatic nerve electrolocation and catheter placement than for the transgluteal approach, the subgluteal approach should also be considered. Compared to electrolocation of the peroneal nerve, electrostimulation of the tibial nerve may offer a higher success rate especially with the transgluteal and lateral popliteal approaches. Furthermore, when performing sciatic and femoral blocks with low volumes of local anesthetics, a multiple-injection technique should be used. MeSH « nerve block » à l'aide de l'opérateur « and ». Les mots clés « lumbar plexus », « psoas compartment », « psoas sheath », « sacral plexus », « fascia iliaca », « lateral Conclusions Objectif : L'objectif de cet examen narratif est de résumer les données probantes dérivées d'études randomisées contrôlées (ERC) concernant les approches et techniques pour les blocs nerveux du membre inférieur. Source : A l'aide des bases de données MEDLINE (janvier 1966 à avril 2007) et EMBASE (janvier 1980 à avril 2007), les termes MeSH (vedette-matière médicale) « lumbosacral plexus », « femoral nerve », « obturator nerve », « saphenous nerve », « sciatic nerve », « peroneal nerve » et « tibial nerve » ont été recherchés et combinés au terme

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Section: Approachesmentioning

confidence: 99%

Section: Techniquesmentioning

confidence: 99%

Section: Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Un bilan des approches et techniques pour les blocs nerveux du membre inférieur

Tran

Clemente

Finlayson

2007

Can J Anesth/J Can Anesth

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“…No Grupo B, além dos procedimentos realizados no Grupo A, fez-se o bloqueio do nervo isquiático com dose única de anestésico local. Para o bloqueio do nervo femoral foi utilizada técnica de Winnie 14 : punção de acesso 1 a 2 cm abaixo do ligamento inguinal e 1 a 2 cm lateralmente à artéria femoral. A agulha foi introduzida com angulação de 30° a 45°, em sentido cefálico.…”

Section: Métodounclassified

“…Group B had the procedures performed in Group A associated with sciatic nerve block with a single dose of the local anesthetic. The technique of Winnie was used for the femoral nerve block 14 : access puncture 1 to 2 cm below the inguinal ligament and 1 to 2 cm lateral to the femoral artery. The needle was introduced at a 30° to 45° angle, cephalad.…”

Section: After Approval By the Ethics Committee On Research Of The Inmentioning

confidence: 99%

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Zugliani

Verçosa

Amaral

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A artroplastia total do joelho (ATJ) promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO:Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9) foi realizado bloqueio do nervo femoral e no Grupo B (n = 8), bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1). RESULTADOS:A mediana do tempo de analgesia (M1) no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001). Não foram observadas complicações atribuíveis às técnicas utilizadas.CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.Unitermos: ANALGESIA: pós-operatória; CIRURGIA, Ortopédica: artroplastia total de joelho; TÉCNICAS ANESTÉSICAS, Regional: bloqueio do nervo femoral, bloqueio do nervo isquiático. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. SUMMARY METHODS:Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluated. RESULTS:The median of the duration of analgesia (M1) in Group A was 110 min, while in Group B it was 1285 min (p = 0.0001). There were no complications related to the technique used.CONCLUSIONS: Sciatic nerve block, when associated with femoral nerve block, under the conditions of the present study, improved significantly the quality of postoperative analgesia in TKA.

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