Use of test dose allows early detection of subdural local anesthetic injection with lumbar plexus block

Lee, Bradley H.; Braehler, Matthias R.

doi:10.1016/j.jclinane.2016.11.011

Cited by 6 publications

(7 citation statements)

References 14 publications

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Section: Discussionmentioning

confidence: 99%

“…Possible causes of IOH after traditional posterior lumbosacral plexus block include nerve root block, local anaesthetics’ epidural space diffusion, sympathetic nerve block, and excessive analgesia ( Lee and Braehler, 2017 ). When performing a lumbosacral plexus block, if the needle point is placed extremely near the foraminal opening, the medication may transfer down the foraminal to the epidural area, resulting in an epidural block ( Lee and Braehler, 2017 ). Furthermore, since the lumbar sympathetic nerve is positioned between the anterolateral lumbar vertebrae and the medial psoas major muscle ( Feigl et al, 2011 ), it may be blocked simultaneously during the lumbar plexus block.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the previous two techniques, conventional posterior lumbosacral plexus block with laryngeal-mask general anaesthesia provided adequate pain relief during surgery, shortened hospital stays, and decreased mortality ( Chen et al, 2018 ; Scurrah et al, 2018 ). However, the posterior lumbosacral plexus also has some disadvantages, such as multiple puncture injections, turning over to change the patient’s position, and intraoperative hypotension (IOH; Aksoy et al, 2014 ; Zhang et al, 2022 ), which may be due to the diffusing local anaesthetics into the epidural area, sympathetic nerve block, or excessive analgesia ( Lee and Braehler, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial

Teng

Wang

Dong

et al. 2023

Front. Mol. Neurosci.

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BackgroundHypotension often occurs during hip surgery in elderly adults with conventional posterior lumbosacral plexus block.PurposeWe conducted a randomised controlled trial to determine if simple iliopsoas space block can lower the incidence of intraoperative hypotension (IOH) and provide sufficient perioperative pain relief during hip fracture surgery in elderly adults.MethodsPatients undergoing surgery for elderly hip fracture were randomised to receive either an anterior iliopsoas space block with a lateral femoral cutaneous nerve block or a posterior lumbosacral plexus block. The primary outcome was a composite measure of IOH incidence comprising frequency, absolute and relative hypotension durations.ResultsCompared to the posterior group, the iliopsoas space block group had a decreased median frequency of IOH [1.09 (0–2. 14) vs. 3 (1.6–4.8), p = 0.001, respectively] along with lower absolute [5 (0–10) min] and relative [minutes below systolic blood pressure of 100 mmHg in % of total anaesthesia time, 6.67 (0–7.65)] duration of IOH compared to the posterior group [35 (10–45) min, p = 0.008; 37.6 (12.99–66.18), p = 0.004, respectively]. The median pain levels in the post-anaesthesia care unit and median intraoperative sufentanil usage were comparable between the iliopsoas space group [2 (1–3); 8 (6–10) μg] and posterior group [1 (0–3); 5 (5–8) μg]. Thermal imaging revealed that the limb injected with the iliopsoas space block had a higher skin temperature than the unblocked limb in the sacral plexus innervated region.ConclusionA single iliopsoas space block lowers the IOH incidence and provides comparable perioperative analgesia to conventional lumbosacral plexus block.Clinical Trial RegistrationTrial registration at www.chictr.org.cn (ChiCTR2100051394); registered 22 September 2021.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial

Teng

Wang

Dong

et al. 2023

Front. Mol. Neurosci.

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“…When the local anesthetics reach the brain stem, they lead to apnea and unconsciousness [ 14 ]. Several cases of subdural injection, but no controlled studies, have been reported [ 13 , 14 , 16 , 28 , 29 ]. Lubenow and colleagues [ 15 ] reported subdural incidence in 18 out of 2182 patients (0.82%) treated by lumbar epidural injection.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

Lee

Sim

Kim

et al. 2020

JCM

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Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

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“…If this is the case, there can be a standardized protocol for lidocaine administration during hip replacement surgeries. Furthermore, experiments in this study found that lidocaine injections were beneficial for postoperative pain compared to more conservative treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) [8][9][10][11][12][13][14]. Physicians can also create standardized procedures for lidocaine use for conditions in hip arthroplasty candidates.…”

Section: Lidocaine Administrationmentioning

confidence: 96%

A Systematic Review of the Usage of Lidocaine in Hip Replacement Surgery

Lu¹,

Reddy²,

Fei³

et al. 2023

Cureus

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Hip replacement procedures, professionally known as hip arthroplasty, are one of the most common orthopedic procedures. Due to the variation in this procedure, the use and types of anesthetics differ. One such commonly used anesthetic is lidocaine. Since there are currently no standardized or general procedures for the application of lidocaine for perioperative hip arthroplasty procedures, this review aims to delve into this topic. A literature review surrounding the key terms "hip replacement" and "lidocaine" was performed on PubMed. After reviewing 24 randomized control trials, statistical analyses between groups that had no lidocaine versus groups that did were performed. The results showed that there was no statistical significance between various age groups and the use of lidocaine. One percent (1%) and 2% injected into the lumbar region were the most commonly reported doses of lidocaine, with 2% often being the first test dose. Other conclusions were that lidocaine was used for general anesthesia for individuals that underwent hip arthroplasty due to an underlying condition (cauda equina syndrome, ankylosing spondylitis, etc.). Lidocaine was also used for postoperative pain relief, which is a potential concern from its addictive qualities. This investigation outlines the current stance and usage of lidocaine in perioperative hip arthroplasty while noting its limitations.

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Use of test dose allows early detection of subdural local anesthetic injection with lumbar plexus block

Cited by 6 publications

References 14 publications

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

A Systematic Review of the Usage of Lidocaine in Hip Replacement Surgery

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