Circumpsoas block ... an anterior myofascial plane block for lumbar plexus elements: case report

Dissimilar Planes and Approaches with Common Neural Targets - A Cadaveric Evaluation of Three Different Ultrasound-guided Fascial Plane Blocks for Lumbar Plexus Nerves

Background

The lumbar plexus (LP) is a group of nerves located at the fourth lumbar vertebra level, between the anterior two-thirds and posterior one-thirds of the psoas muscle. In this study, the researchers aimed to investigate the spread of latex in injections of LP, suprainguinal fascia iliaca, and circum-psoas planes to assess the different regional techniques for blocking LP nerves (LPNs).

Methods

The study involved performing ultrasound-guided injections of three different colored latexes in six cadavers. The researchers observed and compared the spread of latex in each plane by taking cross sections at the levels of L4, anterior superior iliac spine (ASIS), and sacral foramina (SF). The spread of latex and LPN staining was documented and analyzed through photography.

Results

The results showed that the latex spread within the psoas muscle and fascia iliaca plane (FIP) during LP injections, whereas suprainguinal fascia iliaca injections showed latex dissemination in the FIP at both ASIS and SF levels. On the other hand, circum-psoas injections spread beneath the iliopsoas fascia at both levels and medially toward the external iliac vessels. Despite this spread, there was no communication between the three planes, and there was no mixing of latex from the different injections at any level.

Conclusion

There are distinct fascial planes, for the three approaches, with no communication between them. While latex diffused from LP plane to FIP, no mixing of dye was observed and also the reverse could not be achieved. These findings suggest that different regional techniques for blocking LPNs have their unique planes of action.

Circum-Psoas Block versus Supra-Inguinal Fascia Iliaca Block for Postoperative Analgesia in Patients Undergoing Total Hip Arthroplasty: A Randomized Clinical Trial

Purpose

Total hip arthroplasty (THA) is often associated with moderate to severe pain. The present study compared the efficacy of circum-psoas block (CPB) with supra-inguinal fascia iliaca block (SIFIB) for postoperative analgesia in patients undergoing THA.

Patients and Methods

In this randomized trial, sixty-four patients undergoing THA were allocated randomly to the CPB group or SIFIB group with 40 mL of 0.3% ropivacaine. The primary outcome was dynamic pain score at 6 h postoperatively. Secondary outcomes included dynamic pain scores at 12, 24 and 48 h; static pain scores; sensory and motor block; opioid consumption; time to first opioid request; length of hospital stay; patient satisfaction; and adverse events.

Results

CPB patients showed significantly lower dynamic pain scores at 6 (3.11 ± 0.66 vs 4.47 ± 0.74, respectively; P = 0.000), 12 (2.52 ± 0.73 vs 3.53 ± 0.85, respectively; P = 0.000) and 24 h (2.30 ± 0.57 vs 2.87 ± 0.71, respectively; P = 0.001) after surgery, as well as lower static pain scores at 6 and 12h (P = 0.001 and P = 0.033 respectively) than SIFIB patients. Lower opioid consumption was observed in the CPB group at 24 and 48 h (P = 0.000, both) than in the SIFIB group. Patients in the CPB group reported improved quadriceps strength at 6 and 12 h (P = 0.000, both), as well as better muscle strength of hip flexion at 6, 12 and 24 h (P = 0.000, P = 0.000 and P = 0.025 respectively). Compared with SIFIB, CPB was associated with increased sensory block coverage at 6, 12 and 24 h (P = 0.000, P = 0.000, and P =0.022, respectively).

Conclusion

CPB has a greater potential to alleviate postoperative pain and improve recovery in THA patients than SIFIB.

Evaluation of Sensory Loss Obtained by Circum-Psoas Blocks in Patients Undergoing Total Hip Replacement: A Descriptive Pilot Study

Purpose

Methods

Results

Conclusion

Clinical Trial Registration