Clinical study of continuous lumbar plexus block through different approaches on perioperative analgesia in aged proximal femur surgery_West China Medical Journal

Authors：

 ZHOU Ying ¹ , FENG Jing ¹ , DU Peng ¹ , WANG Guanglei ² , LIU Gongjian ²

1. Department of Pain Management, Institute of Health of the Weapons Industry, Xi'an, Shaanxi 710065, P. R. China;
2. Department of Anesthesiology, Affiliated Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

ZHOU Ying, Email: zhouying742004@126.com

Keywords：

Lumbosacral plexus; Nerve block; Intraoperative period; Analgesia; Aged; Femoral fractures

DOI：

10.7507/1002-0179.201609012

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Objective To explore the clinical effect and complications of lumbar plexus block through different approaches on perioperative analgesia in aged proximal femur surgery, and find the best method for analgesia in these patients. Methods From January to December 2015, 150 elderly patients scheduled for proximal femur surgery were randomly divided into three groups: psoas compartment block (PCB group, n=50), Winnie " 3 in 1” block (Winnie group, n=50), and fascia iliaca compartment block (FICB group, n=50). Twelve hours before surgery, guided by ultrasound and nerve stimulator, lumbar plexus blocks were performed in all the patients, then patient-controlled analgesia (the formula and the usage were the same) was done. All patients received epidural anesthesia, and were maintained postoperative analgesia for 72 hours. If Rest Visual Analogue Scale>3 or Initiative Movement Visual Analogue Scale>4, sufentanyl 10 μgi.m. was given. Muscle strength grades and complications were recorded. Anesthetic effect of sensory block of femoral, lateral femoral cutaneous, and obturator nerves were measured and recorded too. Results There were two cases of epidural block, and one case of puncture point bleeding in group PCB; no complication in the other groups was found. There was no remedy for inadequate analgesia in the three groups. Compared with group PCB, the muscle strength grades during postoperative 24–72 hours in group FICB were higher (P<0.05). The successful rate of the block of lateral femoral cutaneous nerves was 64%, 91% and 96% in group Winnie, group PCB and group FICB, respectively, and the differences between the three groups were all statistically significant (P<0.05). The successful rate of the block of obturator nerves in group FICB (62%) was lower than that in group PCB (89%) and Winnie group (84%) (P<0.05). Conclusion Continuous fascia iliaca compartment block on perioperative analgesia in aged proximal femur surgery, with exact effect, less complications and simple operation, is better than the psoas compartment block and Winne " 3 in 1” nerve block.

Citation： ZHOU Ying, FENG Jing, DU Peng, WANG Guanglei, LIU Gongjian. Clinical study of continuous lumbar plexus block through different approaches on perioperative analgesia in aged proximal femur surgery. West China Medical Journal, 2018, 33(9): 1142-1145. doi: 10.7507/1002-0179.201609012 Copy

1.	Kaye AD, Urman RD. Perioperative analgesia and future directions. Best Pract Res Clin Anaesthesiol, 2014, 28(2): 103-104.
2.	Sim IW, Webb T. Anatomy and anaesthesia of the lumbar somatic plexus. Anaesth Intensive Care, 2004, 32(2): 178-187.
3.	Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technique of lumbar plexus anesthesia: the " 3 in 1” block. Anesth Analg, 1973, 52: 989-996.
4.	Flores RA Jr. 3-in-1 block: are we still using this misnomer?. AANA J, 2013, 81(3): 171.
5.	Mcrae PJ, Bendall JC, Madigan V, et al. Paramedic-performed fascia iliaca compartment block for femoral fractures: a controlled trial. J Emerg Med, 2015, 48(5): 581-589.
6.	陈玲敏, 张燕姿, 宋健楠, 等. 全膝关节置换术围手术期疼痛管理. 华西医学, 2016, 31(1): 180-183.
7.	Rahimzadeh P, Imani F, Sayarifard A, et al. Ultrasound-guided fascia iliaca compartment block in orthopedic fractures: Bupivacaine 0.2% or 0.3%?. Med J Islam Repub Iran, 2016, 30(10): 433-436.
8.	Amiri HR, Zamani MM, Safari S. Lumbar plexus block for management of hip surgeries. Anesthesiol Pain Med, 2014, 4(3): e19407.
9.	Xing JG, Abdallah FW, Brull R, et al. Preoperative femoral nerve block for hip arthroscopy: a randomized, Triple-Masked controlled trial. Am J Sports Med, 2015, 43(11): 2680-2687.
10.	袁亮婧, 伊军, 许莉, 等. 阻力消失法定位髂筋膜间隙的准确性: 超声法评价. 中华麻醉学杂志, 2013, 33(3): 331-333.
11.	Dogan Z, Bakan M, Idin K, et al. Total spinal block after lumbar plexus block: a case report. Braz J Anesthesiol, 2014, 64(2): 121-123.
12.	Marhofer P, Schrogendorfer K, Koinig H, et al. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg, 2000, 90(1): 119-124.
13.	Kaldirim Ü, Yolcu Ü. Fascia iliaca compartment block for hip dislocation. Eur J Emerg Med, 2015, 22(2): 145-146.
14.	Pinson S. Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: a review of the literature. Int Emerg Nurs, 2015, 23(4): 323-328.
15.	Van Geffen GJ, Bruhn J, Gielen M. Fascia iliaca compartment block administered by emergency medical service nurses at home. Reg Anesth Pain Med, 2015, 40(1): 87-88.

1. Kaye AD, Urman RD. Perioperative analgesia and future directions. Best Pract Res Clin Anaesthesiol, 2014, 28(2): 103-104.
2. Sim IW, Webb T. Anatomy and anaesthesia of the lumbar somatic plexus. Anaesth Intensive Care, 2004, 32(2): 178-187.
3. Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technique of lumbar plexus anesthesia: the " 3 in 1” block. Anesth Analg, 1973, 52: 989-996.
4. Flores RA Jr. 3-in-1 block: are we still using this misnomer?. AANA J, 2013, 81(3): 171.
5. Mcrae PJ, Bendall JC, Madigan V, et al. Paramedic-performed fascia iliaca compartment block for femoral fractures: a controlled trial. J Emerg Med, 2015, 48(5): 581-589.
6. 陈玲敏, 张燕姿, 宋健楠, 等. 全膝关节置换术围手术期疼痛管理. 华西医学, 2016, 31(1): 180-183.
7. Rahimzadeh P, Imani F, Sayarifard A, et al. Ultrasound-guided fascia iliaca compartment block in orthopedic fractures: Bupivacaine 0.2% or 0.3%?. Med J Islam Repub Iran, 2016, 30(10): 433-436.
8. Amiri HR, Zamani MM, Safari S. Lumbar plexus block for management of hip surgeries. Anesthesiol Pain Med, 2014, 4(3): e19407.
9. Xing JG, Abdallah FW, Brull R, et al. Preoperative femoral nerve block for hip arthroscopy: a randomized, Triple-Masked controlled trial. Am J Sports Med, 2015, 43(11): 2680-2687.
10. 袁亮婧, 伊军, 许莉, 等. 阻力消失法定位髂筋膜间隙的准确性: 超声法评价. 中华麻醉学杂志, 2013, 33(3): 331-333.
11. Dogan Z, Bakan M, Idin K, et al. Total spinal block after lumbar plexus block: a case report. Braz J Anesthesiol, 2014, 64(2): 121-123.
12. Marhofer P, Schrogendorfer K, Koinig H, et al. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg, 2000, 90(1): 119-124.
13. Kaldirim Ü, Yolcu Ü. Fascia iliaca compartment block for hip dislocation. Eur J Emerg Med, 2015, 22(2): 145-146.
14. Pinson S. Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: a review of the literature. Int Emerg Nurs, 2015, 23(4): 323-328.
15. Van Geffen GJ, Bruhn J, Gielen M. Fascia iliaca compartment block administered by emergency medical service nurses at home. Reg Anesth Pain Med, 2015, 40(1): 87-88.

West China Medical Journal

Clinical study of continuous lumbar plexus block through different approaches on perioperative analgesia in aged proximal femur surgery

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