Combination of ultrasound-guided lumbosacral plexus block with anterior quadratus lumborum block in supine position for
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CLINICAL REPORT
Combination of ultrasound‑guided lumbosacral plexus block with anterior quadratus lumborum block in supine position for hip surgery: a case report Shuguang Yang1 · Kun Chen1 · Li Wan1 Received: 6 January 2020 / Accepted: 6 June 2020 © Japanese Society of Anesthesiologists 2020
Abstract It was widely recognized that the procedure of ultrasound-guided lumbar and sacral plexus block is required to be performed in a lateral decubitus position that patients’ hips and knees were bended. It is difficult, however, for patients with hip fractures to change position because of severe pain and confined movements. We here reported a new modified combination of ultrasound-guided lumbosacral plexus block with anterior quadratus lumborum block in supine position that had been successfully applied in one elderly patient who underwent hip surgery. Keywords Lumbosacral plexus block · Quadratus lumborum block · Ultrasound · Total hip arthroplasty
Introduction Both central neuraxial blockade and peripheral nerve blockade can be applied to provide anesthesia for hip arthroplasty. Combination of L1 paravertebral block with lumbar plexus and sciatic nerve block had been validated to have similar hemodynamic efficiency with unilateral spinal anesthesia in partial hip prosthesis for high-risk geriatric patients [1]. However, these two methods require the patients to lie on lateral decubitus position with flexed knee and hip joints. While in this report, given the fact that the elderly patient could not cooperate with changing position like that because of severe pain and confined movements, we developed a new Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00540-020-02811-w) contains supplementary material, which is available to authorized users. * Shuguang Yang [email protected] Kun Chen [email protected] Li Wan [email protected] 1
Department of Anesthesiology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, N.O. 1095 Jiefang Avenue, Wuhan 430030, China
blockade scheme of ultrasound-guided lumbosacral plexus block combined with anterior lumbar quadratus block to allow the patient to receive all the blocks just in supine position.
Case report The patient was a 75 years old female (body weight 40 kg, ASA status III) with hip fracture to undergo total hip arthroplasty, who had been diagnosed as bronchiectasis for more than 8 years. The patient also had a history of open lower lumbar spine surgery for lumbar disc herniation more than 20 years ago, and occasionally had symptoms of backache. However, the patient refused to change position because of severe pain from the fracture site and had intermittent cough with sputum. Considering the potential respiratory complications after general anesthesia and potential difficulties and problems during and after spinal anesthesia, we applied a combination of ultrasound-guided lumbosacral plexus block with anterior quadratus lumborum block in a complete supine positio
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