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Lumbar Plexus Posterior Approach: A Catheter Placement Description Using Electrical Nerve Stimulation

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Abstract

Lumbar plexus anesthesia for major hip and knee surgery is becoming a standard technique (1–4). The inguinal paravascular, or three-in-one, technique is adapted to knee surgery, providing mainly peripheral blockade of the femoral nerve and third lumbar dermatome (5–8). However, at the hip level, blockade of at least the L1 to L4 dermatomes and osteotomes is needed (4). For this, the posterior approach to the lumbar plexus seems more appropriate. A catheter technique allows perioperative top-up injection and postoperative static and dynamic analgesia (2,6,7,9). We have tried to obtain a frequent incidence of total lumbar plexus block with a posterior approach, combining nerve stimulation and catheter insertion. This report presents our technical results with a modified psoas compartment approach. A nerve stimulation-guided procedure was tested prospectively regarding the feasibility and success rate of the method for catheter placement, the extent of sensory and motor blockade obtained, and side effects and complications.
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