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

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

doi:10.1016/j.bjane.2020.04.016

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Revista Brasileira de Anestesiologia

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Scientific Articles • Rev. Bras. Anestesiol. 70 (3) • May-Jun 2020 • https://doi.org/10.1016/j.bjane.2020.04.016 copy

Incidence of epidural spread after Chayen’s approach to lumbar plexus block: a retrospective study^☆ ☆ Internal review board approval. This study was approved by the local Ethical Committee of our institution Comitato Etico Regionale delle Marche, Chairperson Prof. P. Pelaia; Protocol number: 2018/21; Date of approval: 2.2.2018. Written informed consent. The patients gave their written informed consent to the processing of data for this study.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

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.

Method:

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.

Results:

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.

Conclusions:

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.

KEYWORDS
Lumbar plexus block; Psoas compartment block; Hip surgery

Article	Approach	Method	Local anesthetic volume (mL)	Number of patient (n)	Epidural spread (n)
Parkinson⁴4 Parkinson KS, Mueller JB, Little WL, et al. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243-8.	Dekrey	ENS	0.5 kg	25	4
Parkinson⁴4 Parkinson KS, Mueller JB, Little WL, et al. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243-8.	L4/L5	ENS	0.5 kg	23	1
Capdevila⁶6 Capdevila X, Macaire P, Dadure C, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606-13.	Capdevila	ENS	0.4 kg	77	0
Pandin⁷7 Pandin PC, Vandesteene A, D’Hollander AA. Lumbar plexus posterior approach: a catheter placement description using electrical nerve stimulation. Anesth Analg. 2002;95:1428-31.	Chayen	ENS	30	132	2
Biboulet¹⁰10 Biboulet P, Morau D, Aubas P, 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. 2004;29:102-9.	Dekrey	ENS	0.6 kg	15	4
Farny¹¹11 Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with sciatic nerve block using lidocaine. Can J Anaesth. 1994;41:486-91.	Winnie	ENS	25-35	45	4
Stevens¹²12 Stevens RD, Van Gessel E, Flory N, et al. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000;93:115-21.	Winnie	ENS	0.4 kg	28	3
De Biasi¹³13 De Biasi P, Lupescu R, Burgun G, et al. Continuous lumbar plexus block: use of radiography to determine catheter tip location. Reg Anesth Pain Med. 2003;28:135-9.	Capdevila	ENS	30	169	3
Mannion¹⁴14 Mannion S, O’Callaghan S, Walsh M, et al. In with the new, out with the old? Comparison of two approaches for psoas compartment block. Anesth Analg. 2005;101:259-64.	Capdevila	ENS	0.4/kg	30	10
Mannion¹⁴14 Mannion S, O’Callaghan S, Walsh M, et al. In with the new, out with the old? Comparison of two approaches for psoas compartment block. Anesth Analg. 2005;101:259-64.	Winnie	ENS	0.4 kg	30	12
Jankowski¹⁵15 Jankowski CJ, Hebl JR, Stuart MJ, et al. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2003;97:1003-9.	Winnie	ENS	40	18	0
Souron¹⁶16 Souron V, Delaunay L, Schifrine P. Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty. Can J Anaesth. 2003;50:574-9.	Winnie	ENS	25	26	0
Tokat¹⁷17 Tokat O, Turker YG, Uckunkaya N, et al. A Clinical Comparison of Psoas Compartment and Inguinal Paravascular Blocks Combined with Sciatic Nerve Block. J Int Med Res. 2002;30:161-7.	Chayen	ENS	30	15	0

Group (n = 700)
Age (years)	64.7 ± 20.1
Weight (kg)	62.4 ± 8.7
Height (m)	1.63 ± 10.5
BMI (kg. m^-2)	23.5 ± 3.0
Sex (Male/Female)	284/416
ASA physical status
I	67
II	292
III	307
IV	34

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail: rosano.elisabetta@gmail.com (E. Rosanò).