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  • Title: Ultrasound-guided lumbar plexus block using a transverse scan through the lumbar intertransverse space: a prospective case series.
    Author: Karmakar MK, Li JW, Kwok WH, Hadzic A.
    Journal: Reg Anesth Pain Med; 2015; 40(1):75-81. PubMed ID: 25469756.
    Abstract:
    BACKGROUND AND OBJECTIVES: A paramedian transverse scan (PMTS) can be used to delineate the anatomy relevant for ultrasound-guided lumbar plexus block (LPB) through the lumbar intertransverse space. This case series evaluated the feasibility of using the PMTS to guide LPBs for anesthesia. METHODS: After research ethics committee approval and written informed consent, 15 American Society of Anesthesiologists physical status 1 to III patients with body mass index of less than 35 kg/m scheduled for lower-extremity surgery received an ultrasound-guided LPB and a sciatic nerve block for anesthesia. The blocks were performed using the PMTS and in-plane needle insertion. Localization of the lumbar plexus was confirmed by obtaining quadriceps muscle twitch. Successful blocks were defined as adequate anesthesia for lower-extremity surgery in the sensory territory of the lumbar plexus. RESULTS: The articular process and psoas muscle were visualized on ultrasound in all 15 patients (mean age, 46.3 ± 20.4 years; body mass index, 22.2 ± 2.4 kg/m), but the lumbar plexus was identified in two-thirds of the patients. Blocks were successfully performed in 14 (93%) of the 15 patients. Poor visibility in 1 patient (7%) precluded the use of ultrasound guidance. The needle was visualized in the psoas muscle in 14 patients (93%), whereas proper needle location was confirmed in all patients by nerve stimulation. Needle to lumbar plexus contact was delineated on ultrasound in 8 (53%) and 14 patients (93%), before and after injection of local anesthetic, respectively. Adequate anesthesia was accomplished in all patients within 30 minutes of injection. CONCLUSION: Ultrasound-guided LPBs can be reliably accomplished using the PMTS.
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