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Other Regional and Local Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
However, after knee surgery, in particular total knee replacement, femoral nerve blocks impair early functional recovery, although they are superior to systemic opioid analgesia and comparable with epidural analgesia with fewer adverse effects (Fischer et al, 2008). Therefore, adductor canal blocks with minimal effect on motor function are currently the preferred block for total knee replacement as they improve functional recovery (Kuang et al, 2017). Local infiltration analgesia (LIA) has become an increasingly viable alternative to femoral nerve blocks, if performed with the appropriate technique (Andersen & Kehlet, 2014)—see Section 10.5. Continuous lumbar plexus blockade is also effective but not recommended as it carries an increased risk of complications (Fischer et al, 2008).
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The lumbar plexus is a network of nerve fibres that provide motor and sensory innervation to the lower limb. They are formed of the anterior rami of the lumbar spinal nerves from L1–L4 with 50% of cases receiving contribution from T12. The plexus is found anterior to the transverse processes of lumbar vertebrae within the psoas major muscle compartment. These spinal nerves divide into cords and combine to form six major peripheral nerves (Table 6.2 and Figure 6.6).
Blocks of Nerves of the Lumbar Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The lumbar plexus is formed by the fusion of the ventral rami of the first four lumbar spinal nerves (Figure 2.1, A and B). It usually receives a branch from the twelfth thoracic nerve and gives a branch (from the fourth lumbar spinal nerve) to the sacral plexus. The lumbar plexus lies within the substance of the psoas major muscle, in a fascial plane delineated by (1) the dorsal muscle mass attached to the transverse processes of the lumbar vertebrae, (2) the ventral mass attached to the vertebral bodies and intervertebral disks, and (3) the bodies and transverse processes of the lumbar vertebrae (Figures 2.1C and 2.2). This fascial plane has been termed “psoas compartment” by Chayen et al.12
Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Lin Liheng, Cai Siyuan, Cai Zhen, Wu Changxue
Several complications related to ESPB have been described in previous studies. Hamilton [45] reported one case of pneumothorax following ESPB; Elkoundi [46] described a priapism; O Selvi [47] reported an unexpected case of motor weakness; Karaca [48] described a LAST (local anesthetic systemic toxicity) following high dose lumbar erector spinae plane block. A retrospective review [49] revealed that 4 of the 182 patients experienced side effects. In these four complications, one case was perhaps related to the spread of the LA to the lumbar plexus, and three cases were considered to be associated with the LA toxicity possibly. Although no major LAST complications such as seizures have been observed, the rate of the LA toxicity was a little high. There is, therefore, a significant need to determine the effective and safe volume and concentration of the local anesthetic.
Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures
Published in The Neurodiagnostic Journal, 2021
W. Bryan Wilent, Julie M. Trott, Anthony K. Sestokas
There are certain procedures in which there is an elevated risk of nerve root or plexus injury, and MEPs have been shown to have value in diagnosing and avoiding such injuries (Aleem et al. 2018; Bhalodia et al. 2013; Lieberman et al. 2019; Riley et al. 2018; Wilent et al. 2020b). The lateral approach to the lumbar spine puts the lumbar plexus at increased risk of injury, and many modalities, including MEPs, have been utilized to limit these injuries (Epstein 2019; Riley et al. 2018). Posterior procedures involving the L5 vertebra (L4-L5 or L5-S1 intervertebral junctions) may pose an increased risk of injury to the L5 nerve root, placing the patient at an increased risk of “foot drop” dorsiflexion injury (Wilent et al. 2020b). This risk is further elevated in patients undergoing pedicle subtraction osteotomy, transforaminal lumbar interbody fusion, or in patients with a diagnosis of high-grade spondylolisthesis (de Kunder et al. 2017; Lieberman et al. 2019). The value of IONM is predicated on the degree of risk to the nervous system; when there is an elevated risk of nerve root injury, such as with the aforementioned diagnoses and procedures, MEPs have an increased value, and the rationale for inclusion is stronger.
Effect of ultrasound-guided L1/L2 paravertebral block in decreasing drug requirements during general anesthesia in patients undergoing hip surgeries; randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2020
Bassant Mohamed Abdelhamid, Mohamed Ibrahim Belita, Hala Mostafa Gomaa, Mohamed Saeid Ali, Ahmed Abdalla Mohamed, Mohamed Mahmoud Hassan
Wardhan R et al. studied the use of L1 to L2 single-shot lumbar paravertebral blocks and found that there is an opioid-sparing effect with fewer complications such as epidural spread. Moreover, it maintains hip flexor and quadriceps strength more than the lumbar plexus block with an advantage of early ambulation and discharge [11]. Also, the use of lumbar plexus block decreases morphine consumption not as much as with continuous L2 lumbar paravertebral block. Likewise, there was no difference between both techniques regarding motor power preservation. Finally, they found that there is no real advantage in switching to L2 lumbar paravertebral block. On the other hand, the authors recommend the use of lumbar paravertebral block as an alternative to lumbar plexus block in the terms of safety as there is a high potential for complications in lumbar plexus block.