The Psoas Compartment Block

Chayen, David; Nathan, Hílel; Chayen, M. S.

doi:10.1097/00000542-197607000-00019

Cited by 258 publications

(139 citation statements)

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“…The L,, approach (the 'psoas compartment block') involves identifying the fifth lumbar transverse process and gliding the needle cephalad to it (between the fourth and fifth lumbar transverse processes) [6]. Technical difficulties with this approach include location of the transverse process sufficiently lateral to avoid the epidural and subarachnoid space, and difficulty in manipulating the needle between the transverse processes.…”

Section: Discussionmentioning

confidence: 99%

Lumbar plexus block: an anatomical study

Hanna¹,

Peat²,

D'costa³

1993

Anaesthesia

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SummaryThe anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L , interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. In all cases, dye was confined to the posterior part of the psoas muscle, and tracked down the nerves of the lumbar plexus. No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug dispositon being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening. Key wordsAnaesthesia, regionat lumbar plexus block.Regional techniques for anaesthesia and analgesia of the lower limb have been historically regarded as more difficult than those for the upper limb. It has been assumed that the depth of the lumbar plexus and the distance between its roots make it difficult to locate, necessitating multiple procedures and resulting in a high failure rate [1,2]. Despite these difficulties a variety of techniques for lumbar plexus blockade have been described for use in the management of chronic pain, and in the provision of surgical analgesia for adults and children [3].Both posterior and anterior approaches to the plexus have been described: (a) paravertebral approaches using either multiple injections at each root of the plexus Although it has been used for many years, it has never been published, and no previous anatomical studies have been undertaken.between the psoas and quadratus lumborum muscles, (which contain part of the lumbar plexus as it emerges from the lateral side of psoas major) or into the posterior part of the psoas muscle at this level [5-71; (d) anterior approaches where the needle is placed lateral to the femoral artery in the inguinal region (inguinal paravascular technique [8]) or immediately behind the fascia iliaca at a point two-thirds laterally along the inguinal ligament [9].In recent assessments of the extent of sensory and motor blockade achieved with different approaches to the lumbar plexus, the posterior approaches were found to result in a more extensive block than were the anterior approaches [5,9]. Although the posterior approaches are likely to result in superior lumbar plexus anaesthesia, they may be technically more difficult and may be associated with inadvertent extradural or subarachnoid block, particularly if large volumes of local anaesthetic are used [5,10].The present study was performed to assess the location and spread of a dye injected via a posterior approach without X ray control to the lumbar plexus at the LZT3 interspace. MethodsHospital ethics committe...

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Section: Discussionmentioning

confidence: 99%

Lumbar plexus block: an anatomical study

Hanna¹,

Peat²,

D'costa³

1993

Anaesthesia

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“…However, cysts in interspinous ligaments [4], gaps in the ligamentum flavum [5][6][7], the paravertebral spaces [8] and intermuscular planes [9] can also yield a 'false' loss-ofresistance. Pressure waveform analysis provides a simple confirmatory adjunct to loss-of-resistance; when the needle (or catheter) is correctly positioned inside the epidural space, a pulsatile waveform synchronised with arterial pulsations will be seen [2].…”

Section: Introductionmentioning

confidence: 99%

Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

et al. 2017

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SummaryPressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-ofresistance). Sterile extension tubing, connected to a pressure transducer, was attached to the needle. An investigator determined the presence or absence of a pulsatile waveform, synchronised with the heart rate, on a monitor screen that was not in the view of the anaesthetist or the parturient. A bolus of 4 ml lidocaine 2% with adrenaline 5 lg.ml À1 was administered, and the epidural block was assessed after 15 min. Three women displayed no sensory block at 15 min. The results showed: epidural block present, epidural waveform present 93; epidural block absent, epidural waveform absent 2; epidural block present, epidural waveform absent 4; epidural block absent, epidural waveform present 1. Compared with the use of a local anaesthetic bolus to ascertain the epidural space, the sensitivity, specificity, positive and negative predictive values of waveform analysis were 95.9%, 66.7%, 98.9% and 33.3%, respectively. Epidural waveform analysis provides a simple adjunct to loss-of-resistance for confirming needle placement during performance of obstetric epidurals, however, further studies are required before its routine implementation in clinical practice.

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“…While performing the psoas compartment block for unilateral lumbar anesthesia, the loss of resistance technique, similar to that used for an epidural block, is employed as described by Chayen and Winnie [3,4].Although the actual anatomical existence of this compartment is debated by others, a distinct loss of resistance is felt when the epidural needle penetrates the anterior fascia of the quadratus lumborum muscle [5,6].…”

Section: Discussionmentioning

confidence: 99%

Pneumoretroperitoneum after Attempted Epidural Anesthesia

Isakov

Shtein

Kyzer

2016

The Journal of Critical Care Medicine

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Air may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described. Case reportAn 81-year-old, Caucasian, male, weight 72 kg, height 178 cm, was admitted due to fracture of the neck of the right femur. The patient was operated on, and internal fixation of the fracture was performed. Epidural anesthesia at the L4-5 level in the right the lateral position was performed by a second-year anesthesia resident. A midline approach and an 18G Tuohy needle were used. The procedure was technically difficult, and a total of three attempts were made. Loss of resistance with air was used. During the efforts to identify the epidural space, some 30 to 35 milliliters of air had been injected. Subjective loss of resistance was reported by the performing anesthesiologist. However, he was unable to insert an epidural catheter. Local anesthetic was not injected. The procedure was eventually carried out without intraoperative complications under general anesthesia. On the fourth postoperative day, the patient developed continuous abdominal pain of moderate severity. On examination, there were no signs of peritoneal irritation. However, an abdominal CT scan demonstrated air in the retroperitoneum around the left psoas muscle (Figure 1). Because the patient had received an enema on the third postoperative day, a gastrografin enema was performed to rule out rectal or colonic perforation. No leak was demonstrated. CT examination confirmed air around the left psoas muscle which extended to the left paravertebral muscles. There was no air around the pelvic organs or at the site of the femoral fixation. The patient's condition improved gradually, and he was discharged on the seventh postoperative day. The patient agreed with presentation of his data and all the procedures performed were approved by the institution where the patient was treated.

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The Psoas Compartment Block

Cited by 258 publications

References 0 publications

Lumbar plexus block: an anatomical study

Lumbar plexus block: an anatomical study

Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women

Pneumoretroperitoneum after Attempted Epidural Anesthesia

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