Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Scientific Article

Incidence of epidural spread after Chayen’s approach to lumbar plexus block: a retrospective study

Incidência de dispersão peridural após bloqueio do plexo lumbar com técnica de Chayen: estudo retrospectivo

Elisabetta Rosanò, Diego Tavoletti, Giulia Luccarelli, Elisabetta Cerutti, Luca Pecora

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Background and objectives
The lumbar plexus block (LPB) is a key technique for lower limb surgery. All approaches to the LPB involve a number of complications. We hypothesized that Chayen's approach, which involves a more caudal and more lateral needle entry point than the major techniques described in the literature, would be associated with a lower rate of epidural spread.

We reviewed the electronic medical records and chart of all adult patients who underwent orthopedic surgery for Total Hip Arthroplasty (THA) and hip hemiarthroplasty due to osteoarthritis and femoral neck fracture with LPB and Sciatic Nerve Block (SNB) between January 1, 2002, and December 31, 2017, in our institute. The LPB was performed according to Chayen’s technique using a mixture of mepivacaine and levobupivacaine (total volume, 25 mL) and a SNB by the parasacral approach. The sensory and motor block was evaluated bilaterally during intraoperative and postoperative period.

A total number of 700 patients with American Society of Anesthesiologists (ASA) physical status I to IV who underwent LPB met the inclusion criteria. The LPB and SNB was successfully performed in all patients. Epidural spread was reported in a single patient (0.14%;p < 0.05), accounting for an 8.30% reduction compared with the other approaches described in the literature. No other complications were recorded.

This retrospective study indicates that more caudal and more lateral approach to the LPB, such as the Chayen’s approach, is characterized by a lower epidural spread than the other approach to the LPB.


Lumbar plexus block;  Psoas compartment block;  Hip surgery


Justificativa e objetivos
O Bloqueio do Plexo Lombar (BPL) é uma técnica fundamental para a cirurgia de membros inferiores. Todas as abordagens do BPL são associadas a uma série de complicações. Nossa hipótese foi de que a abordagem de Chayen, que envolve um ponto de entrada da agulha mais caudal e mais lateral do que as principais técnicas descritas na literatura, estaria associada a menor incidência de dispersão peridural.

Revisamos os prontuários médicos eletrônicos e em papel de todos os pacientes adultos submetidos à Artroplastia Total do Quadril (ATQ) e hemiartroplastia do quadril devido a osteoartrite ou fratura do colo do fêmur empregando-se BPL associado ao Bloqueio do Nervo Ciático (BNC), entre 1 de Janeiro de 2002 e 31 de Dezembro de 2017 em nossa instituição. Realizamos o BPL usando a técnica de Chayen e uma mistura de mepivacaína e levobupivacaína (volume total de 25 mL) e o BNC pela abordagem parassacral. Testes sensorial e motor bilaterais foram realizados no intra e pós-operatório.

Os critérios de inclusão foram obedecidos pelo total de 700 pacientes classe ASA I a IV submetidos ao BPL. Os BPL e BNC foram realizados com sucesso em todos os pacientes. A dispersão peridural foi relatada em um único paciente (0,14%; p < 0,05), representando uma redução de 8,30% quando comparada às outras abordagens descritas na literatura. Nenhuma outra complicação foi registrada.

Este estudo retrospectivo indica que a abordagem mais caudal e mais lateral do BPL, como a técnica de Chayen, é caracterizada por menor dispersão peridural do que outras abordagens do BPL.


Bloqueio do plexo lombar;  Bloco do compartimento do Psoas;  Cirurgia de quadril


1 A.P. Winnie, S. Ramamurthy, Z. Durrani The inguinal paravascular technic of lumbar plexus anesthesia: the “3 in 1 block” Anesth Analg., 52 (1973), pp. 989-996

2 A.P. Winnie, S. Ramamurthy, Z. Durrani, et al. Plexus blocks for lower extremity surgery: new answers to old problems Anesthesiology Review., 1 (1974), pp. 11-16

3 D. Chayen, H. Nathan, M. Chayen The psoas compartment block Anesthesiology., 45 (1976), pp. 95-99

4 K.S. Parkinson, J.B. Mueller, W.L. Little, et al. Extent of blockade with various approaches to the lumbar plexus Anesth Analg., 68 (1989), pp. 243-248

5 M.H. Hanna, S.J. Peat, F. D’Costa Lumbar plexus block: an anatomical study Anaesthesia., 48 (1993), pp. 675-678

6 X. Capdevila, P. Macaire, C. Dadure, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation Anesth Analg., 94 (2002), pp. 1606-1613

7 P.C. Pandin, A. Vandesteene, A.A. D’Hollander Lumbar plexus posterior approach: a catheter placement description using electrical nerve stimulation Anesth Analg., 95 (2002), pp. 1428-1431

8 P. Bruelle, P. Cuvillon, J. Ripart, et al. Sciatic nerve block: Parasacral approach Reg Anesth., 23 (1998), p. 78

9 S. Kampe, P. Kiencke, A. Delis, et al. The continuous epidural infusion of ropivacaine 0.1% with 0.5 microg mL-1 sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study Can J Anaesth, 50 (2003), pp. 580-585

10 P. Biboulet, D. Morau, P. Aubas, et al. Postoperative analgesia after total-hip arthroplasty: comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study Reg Anesth Pain Med., 29 (2004), pp. 102-109

11 J. Farny, M. Girard, P. Drolet Posterior approach to the lumbar plexus combined with sciatic nerve block using lidocaine Can J Anaesth., 41 (1994), pp. 486-491

12 R.D. Stevens, E. Van Gessel, N. Flory, et al. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty Anesthesiology., 93 (2000), pp. 115-121

13 P. De Biasi, R. Lupescu, G. Burgun, et al. Continuous lumbar plexus block: use of radiography to determine catheter tip location Reg Anesth Pain Med., 28 (2003), pp. 135-139

14 S. Mannion, S. O’Callaghan, M. Walsh, et al. In with the new, out with the old? Comparison of two approaches for psoas compartment block Anesth Analg., 101 (2005), pp. 259-264

15 C.J. Jankowski, J.R. Hebl, M.J. Stuart, et al. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy Anesth Analg., 97 (2003), pp. 1003-1009

16 V. Souron, L. Delaunay, P. Schifrine Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty Can J Anaesth., 50 (2003), pp. 574-579

17 O. Tokat, Y.G. Turker, N. Uckunkaya, et al. A Clinical Comparison of Psoas Compartment and Inguinal Paravascular Blocks Combined with Sciatic Nerve Block J Int Med Res., 30 (2002), pp. 161-167

18 S. Mannion, J. Barrett, D. Kelly, et al. A description of the spread of injectate after psoas compartment block using magnetic resonance imaging Reg Anesth Pain Med., 30 (2005), pp. 567-571

19 P.J. Evans, J.W. Lloyd, G.J. Wood Accidental intrathecal injection of bupivacaine and dextran Anaesthesia., 36 (1981), pp. 685-687

20 J.C. Gadsden, D.M. Lindenmuth, A. Hadzic, et al. Lumbar plexus block using high-pressure injection leads to contralateral and epidural spread Anesthesiology., 109 (2008), pp. 683-688

21 A. Chudinov, H. Berkenstadt, M. Salai, et al. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures Reg Anesth Pain Med., 24 (1999), pp. 563-568

22 R. Brull, C.J. McCartney, V.W. Chan, et al. Neurological complications after regional anesthesia: contemporary estimates of risk Anesth Analg., 104 (2007), pp. 965-974

23 M.J. Barrington, S.A. Watts, S.R. Gledhill, et al. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications Reg Anesth Pain Med., 34 (2009), pp. 534-541

24 Y. Auroy, D. Benhamou, L. Bargues, et al. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service Anesthesiology., 97 (2002), pp. 1274-1280

25 S. Aida, H. Takahashi, K. Shimoji Renal subcapsular hematoma after lumbar plexus block Anesthesiology., 84 (1996), pp. 452-455

26 X. Capdevila, C. Coimbra, O. Choquet Approaches to the lumbar plexus: success, risks, and outcome Reg Anesth Pain Med., 30 (2005), pp. 150-162

27 R.S. Weller, J.C. Gerancher, J.C. Crews, et al. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated Anesthesiology., 98 (2003), pp. 581-585

28 C. Aveline, F. Bonnet Delayed retroperitoneal haematoma after failed lumbar plexus block Br J Anaesth., 93 (2004), pp. 589-591

29 S.M. Klein, F. D’Ercole, R.A. Greengrass, et al. Enoxaparin associated with psoas hematoma and lumbar plexopathy after lumbar plexus block Anesthesiology., 87 (1997), pp. 1576-1579

30 C. Pham-Dang, S. Beaumont, H. Floch, et al. Acute toxic accident following lumbar plexus block with bupivacaine Ann Fr Anesth Reanim., 19 (2000), pp. 356-359

31 T.F. Bendtsen, K. Søballe, E.M. Petersen, et al. Ultrasound guided single injection lumbosacral plexus blockade for hip surgery anaesthesia Br J Anaesth., 111 (2013)

32 K. Birnbaum, A. Prescher, S. Hessler, K.D. Heller The sensory innervation of the hip joint- an anatomical study Surg Radiol Anat, 19 (1997), pp. 371-375

33 V. de Visme, F. Picart, R. Le Jouan, et al. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly Reg Anesth Pain Med., 25 (2000), pp. 158-162

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