Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.015
Brazilian Journal of Anesthesiology
Case Report

Circumpsoas block – an anterior myofascial plane block for lumbar plexus elements: case report

Bloqueio circumpsoas – bloqueio do plano miofascial anterior para elementos do plexo lombar: relato de caso

Sandeep Diwan, Abhijit Nair, Nitin Gawai, Dipal Shah, Parag Sancheti

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Abstract

In an attempt to improvise the analgesia in patients with femoral fractures, we aimed at depositing local anesthetic deep to anterior psoas fascia (APf) under ultrasound (US) guidance to block lumbar plexus elements which emerge lateral, anterior, and medial to the psoas major muscle. We termed this as circumpsoas block (CPB). Clinical and computed tomography contrast studies revealed that a continuous CPB infusion with a catheter provided a reliable block of the lumbar plexus elements. No adverse were events noted. We conclude that US guided CPB is a reliable technique for managing postoperative pain after surgery of femur fractures.

Keywords

Femur,  Intertrochanteric fracture,  Ultrasonography,  Regional Anesthesia,  Acute pain,  Postoperative pain

Resumo

Na tentativa de improvisar a analgesia em pacientes com fraturas de fêmur, objetivamos depositar anestésico local profundamente na fáscia anterior do psoas (fPA) sob orientação ultrassonográfica (US) para bloquear os elementos do plexo lombar que emergem lateral, anterior e medialmente ao psoas maior músculo. Chamamos isso de bloqueio circumpsoas (BCP). Estudos contrastados clínicos e de tomografia computadorizada revelaram que a infusão contínua de BCP com cateter proporcionou bloqueio confiável dos elementos do plexo lombar. Nenhum evento adverso foi observado. Concluímos que o BCP guiado por US é uma técnica confiável para o manejo da dor pós-operatória após cirurgia de fraturas de fêmur.

Palavras-chave

Fêmur; Fratura intertrocantérica; Ultrassonografia; Anestesia Regional; Dor aguda; Dor pós-operatória

References

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2. M. Desmet, A.L. Balocco, V. Van Belleghem Fascia iliaca compartment blocks: Different techniques and review of the literature Best Pract Res Clin Anaesthesiol, 33 (2019), pp. 57-66

3. M. Desmet, K. Vermeylen, I. Van Herreweghe, et al. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty Reg Anesth Pain Med, 42 (2017), pp. 327-333

4. K. Vermeylen, M. Desmet, I. Leunen, et al. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study Reg Anesth Pain Med (2019), 10.1136/rapm-2018-100092 Ahead of print

5. L. Kirchmair, P. Lirk, J. Colvin, et al. Lumbar plexus and psoas major muscle: not always as expected Reg Anesth Pain Med, 33 (2008), pp. 109-114

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Braz J Anesthesiol

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