The comparative study of two techniques of lumbar plexus block by anterior and posterior approach for lower limb surgery

• Main Authors: Milon Vasant Mitragotri, Pushpa Ishwarlal Agrawal, Vaishnavi V Kulkarni, Nilambree S Adke, Dharmesh Arvind Ladhad
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: Indian Journal of Pain
• Online Access: http://www.indianjpain.org/article.asp?issn=0970-5333;year=2017;volume=31;issue=3;spage=146;epage=151;aulast=Mitragotri

Background: Lower extremity peripheral nerve blocks (PNBs) have been traditionally less employed compared to other forms of regional anesthesia. The advent of peripheral nerve stimulator and ultrasonography, complications associated with neuraxial anesthesia, and improved rehabilitation with PNBs has led to renewed interest in lower limb blocks. Lumbar plexus block can be given by anterior (Winnie's “3 in 1” block) and posterior (psoas compartment block) approaches. Subjects and Methods: In this randomized, observer-blinded study, we compared these techniques in two groups of patients (Group A [n = 30] and Group P [n = 30]) undergoing lower limb surgeries using nerve locator. They were supplemented with sciatic nerve block by Labat's approach. The primary objective was to compare the onset of sensory and motor blockade. Secondary objectives included the duration of sensory and motor blockade, sparing of nerves and complications if any. The onset of sensory analgesia was assessed by visual analog scale <3 and motor blockage by modified Bromage scale. For data analysis, t-test and Chi-square test were applied. Results: In Group A, onset of sensory block was 4.816 ± 0.932 min, and in Group P, 17.167 ± 2.364 min. In Group A, the onset of motor action was 7.833 ± 1.227 min, and in Group P, 22.8 ± 4.42 min. The duration of motor block was 5.6 ± 1.07 h in group A and 5.88 ± 0.90 h in Group P. The duration of sensory block was found to be 8.18 ± 1.32 h in Group A and 8.18 ± 0.88 h in Group P. Conclusion: Winnie's 3-in-1 block is associated with rapid onset of sensory and motor block but is associated with sparing of lateral femoral cutaneous nerve and obturator nerve causing inadequate analgesia and tourniquet pain needing additional block or sedation compared to psoas compartment block which provides denser block.