Clinical Pearl for a Successful and Safe PNS Guided Peripheral Nerve Block
Vol 2 | Issue 2 | July-December 2021 | Page 143-144 | Ritesh Roy, Himjyoti Das, Neha Singh, Surajit Giri, Hetal Vadera, Vrushali Ponde
DOI: 10.13107/ijra.2021.v02i02.044
Authors: Ritesh Roy [1], Himjyoti Das [2], Neha Singh [3], Surajit Giri [4], Hetal Vadera [5], Vrushali Ponde [6]
[1] Department of Anaesthesia and Pain management Care Hospitals, Bhubaneswar, Odisha, India.
[2] Anesthesia and Critical care, Nazareth Hospital, Shillong, Assam, India.
[3] Department of Anesthesiology and Critical care, AIIMS, Bhubaneswar, Odisha, India.
[4] Department of Anesthesia, Pragati Hospital, Sivasagar, Assam, India.
[5] Department of Anaesthesia, Sterling Hospital, Rajkot, Gujarat, India.
[6] Department Anesthesiology, Surya Children Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Vrushali Ponde,
Consultant Paediatric Anaesthesiologist, Surya Children Anaesthesia Services, Mumbai, Maharashtra, India.
E-mail: vrushaliponde@yahoo.co.in
Clinical Pearl for a Successful and Safe PNS Guided Peripheral Nerve Block
PRE OP PREPARATION
Pre-procedural evaluation with history of antiplatelet or antithrombotic drug use
Assess neurological status in patient with trauma and neuropathy
Explain the procedure and complications
Possibilities of failure of the procedure, multiple injections and conversion to GA must be explained
Obtain informed written consent
PRE PROCEDURE PREPARATION ( AORA Check list)
Perform the block in a dedicated block room or in OT
Confirm the site before starting the procedure
Block room must be equipped with monitoring devices and equipment
Ensure all resuscitative emergency drugs, equipment and Intralipid present in the cart
Secure venous access before performing the procedure
Connect monitor for ECG, Non-invasive blood pressure (NIBP), and peripheral oxygen saturation
BEFORE GIVING BLOCK
STOP BEFORE YOU BLOCK: Confirm again about patient and site of block
Calculate and keep drugs needed for block in labelled syringes ready before the procedure
Maintain asepsis throughout the procedure
A small dose of sedative / anxiolytic may be necessary for anxious patients. Infiltrate the injection site with lignocaine.
Positive electrode is Red, and negative is Black (Positive is attached to patient, negative end is attached to the Needle). Machines may have different colour coding for the electrodes
PNS stimulation is not possible in patient receiving neuromuscular blocking agent
Presence of neuraxial anaesthesia doesn’t affect the stimulation of intact motor unit by PNS
BLOCK PROCEDURE
Always use insulated needle
For superficial blocks: Use 50 mm needle, current at 1.0 mA.
For deeper blocks: Use 100 mm needle, current at 1.5 mA
Set PNS in 0.2ms current duration & frequency at 2 Hz.
End motor response (EMR) between 0.3mA to 0.5mA is considered safe and ideal (except lumbar plexus block where below 0.5mA is unsafe).
For children 25mm needle is preferred.
Repeated aspiration before injection of drug at 3-5ml aliquot is a safe practice.
Never try to inject against high resistance, use of injection pressure monitoring device is advisable.
Keep talking to the patient while injecting the drug for early detection of the signs of the toxicity.
Injection of Dextrose solution is preferred over sodium chloride for hydro dissection as saline will abolish muscle twitches.
DESIRABLE END MOTOR RESPONSE
| Nerve Block | Response |
| Interscalene Brachial plexus block | Any two contractions of pectoralis major, deltoid, triceps or biceps. |
| Supraclavicular Brachial plexus block | Finger or wrist twitches (flexion or extension) |
| Infraclavicular Brachial Plexus Block | Posterior cord response is desirable (Extension of wrist and fingers) |
| Axillary Brachial Plexus Block | Median nerve- Flexion of first three fingers
Musculocutaneous nerve- Elbow flexion Radial nerve- Fingers extension Ulnar nerve- Flexion of fourth &little finger along with apposition of thumb towards little finger |
| Femoral Nerve Block | Dancing of patella (Twitches of quadriceps muscle) |
| Sciatic Nerve Block | Planter flexion or dorsi flexion |
| Lumbar Plexus Block | Quadriceps contraction |
| Ilioinguinal & Iliohypogastric Nerve Block | Lower Abdominal muscle & Inguinal region Twitches (T10-L1 territory) |
| Thoracic Paravertebral Block | Corresponding intercostal muscles twitches |
| Serratus Anterior Plane (SAP) Block | Serratus anterior muscle twitches/ Dancing of Scapula. |
| PEC1 Block | Pectoralis Major muscle twitches |
AFTER PROCEDURE
Document the procedure. Date, Time, Needle type, size, disappearance of EMR at what current, setting of the PNS before injection of the drug, injection resistance or ease of injection, tingling or numbness during or immediately after injection, vitals etc.
Assessment of Dermatome, Myotome and osteotome at 30minute. If all are blocked, then only we can proceed for incision and surgery
| How to Cite this Article: Roy R, Das H, Singh N, Giri S, Vadera H, Ponde V | Clinical Pearl For A Successful And Safe PNS Guided Peripheral Nerve Block | July-December 2021; 2(2): 143-144.
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Continuous Caudal Catheters in Neonatal Population: A Focussed Review
Vol 2 | Issue 2 | July-December 2021 | Page 124-130 | Vrushali Ponde, Kriti Puri, Nandini Dave
DOI: 10.13107/ijra.2021.v02i02.040
Authors: Vrushali Ponde [1], Kriti Puri [2], Nandini Dave [3]
[1] Department of Anaesthesia, Surya Children Anaesthesia Services, Mumbai, Maharashtra, India.
[2] Department of Anaesthesia, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[3] Department of Anaesthesia, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Vrushali Ponde,
Consultant Paediatric Anaesthesiologist, Surya Children Anaesthesia Services, Mumbai, Maharashtra, India.
E-mail: vrushaliponde@yahoo.co.in
Abstract
Caudal epidural block is one of the most commonly administered blocks in paediatric population. Continuous caudal technique offers several advantages like its ability to cater to long duration surgeries, higher thoracic procedures and to deliver extended, titratable post-operative pain relief. Current advances in this technique like use of fluoroscopy, electrical stimulation and Ultrasound to secure continuous caudal catheters facilitate enhanced accuracy and safety and should be adopted wherever feasible. An understanding of local anaesthetic dosages for infusion and their fine tuning is a prerequisite. The potential benefits and risks should be assessed on a case-to-case bases
Keywords: Caudal anaesthesia, Post-operative pain, Neonatal regional anaesthesia
References
1. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517.
2. Bosenberg AT, Bland BAR, Schulte-Steinberg O, Downing JW. Thoracic epidural anaesthesia via the caudal route in infants. Anaesthesiology 1988;69:265-9.
3. Kil HK. Caudal and epidural blocks in infants and small children: historical perspective and ultrasound-guided approaches. Korean J Anesthesiol. 2018;71(6):430-439. doi:10.4097/kja.d.18.00109.
4. Simpao A, Gálvez J, Wartman E, England W, Wu L, Rehman M et al. The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants. Anesthesia & Analgesia. 2019;129:477-481.
5. Baidya D, Pawar D, Dehran M, Gupta A. Advancement of epidural catheter from lumbar to thoracic space in children: Comparison between 18G and 23G catheters. Journal of Anaesthesiology Clinical Pharmacology. 2012;28:21.
6. Ponde VC, Bedekar VV, Desai AP, Puranik KA. Does ultrasound guidance add accuracy to continuous caudal epidural catheter placements in neonates and infants? Paediatr Anaesth. 2017 Oct;27(10):1010-1014.
7. Bachman SA, Taenzer AH. Thoracic caudal epidural catheter localization using ultrasound guidance. Paediatr Anaesth. 2020 Feb;30:194-195.
8. Daftary S, R Jagtap. Caudal epidural as a sole anaesthetic in preterm, former preterm and high-risk infants. Indian J. Anaesth. 2005;49:195-198.
9. Uguralp S, Mutus M, Koroglu A, Gurbuz N, Koltuksuz U, Demircan M. Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children. J Pediatr Surg. 2002 ;37:610-3.
10. Raghavendran S, Diwan R, Shah T, Vas L. Continuous caudal epidural analgesia for congenital lobar emphysema: a report of three cases. Anaesth Analg. 2001Aug;93:348-50.
11. Carolis MPD, Bersani I, Piersigili F et al. Peripheral nerve blockade and neonatal limb ischemia: Our experience and literature review. Clinical and applied thrombosis/ haemostasis. 2014 Jan:55-60.
12. Luz G, Ladner E, Innerhofer P, Deusch E. Accidents following extradural analgesia in children. The results of a retrospective study. Paediatr Anaesth 1995;5:273.
13. McNeely J, Faber N, Rusy L, Hoffman G. Epidural analgesia improves outcome following paediatric fundoplication: a retrospective analysis. Reg Anaesth 1997; 22: 16-23.
14. Lin, Y.C, Sentivany Collins S.K, Peterson K.L, Boltz M.G and Krane E.J. Outcomes after single injection caudal epidural versus continuous infusion epidural via caudal approach for postoperative analgesia in infants and children undergoing patent ductus ligation. Paediatr Anaesth 1999; 9:134-143.
15. Bosenberg A. Benefits of regional anesthesia in children. Paediatr Anaesth. 2012 Jan;22:10-8.
16. Koo BN, Hong JY, Song HT, Kim JM, Kil HK. Ultrasonography reveals a high prevalence of lower spinal dysraphismin childrenwith urogenital anomalies. Acta Anaesthesiol Scand. 2012;56:624–8.
17. Tsui BC, Seal R, Koller J. Thoracic epidural catheter placement via the caudal approach in infants by using electrocardio- graphic guidance. Anesth Analg. 2002;95:326–330.
18. Tsui BC, Seal R, Koller J, Entwistle L, Haugen R, Kearney R. Thoracic epidural analgesia via the caudal approach in pediat- ric patients undergoing fundoplication using nerve stimulation guidance. Anesth Analg. 2001;93:1152–1155.
19. Tobias J.D. Caudal epidural block : Review of test dosing and recognition of systemic injection in children. Anaesth Analg. 2001;93:1156-61.
20. Suresh S, Ecoffey C, Bosenberg A, et al. The European society of regional anaesthesia and pain therapy/American society of regional anesthesia and pain medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia. Reg Anesth Pain Med 2018; 43: 211-6.
21. Gibbs A, Kim SS, Heydinger G, Veneziano G, Tobias J. Postoperative Analgesia in Neonates and Infants Using Epidural Chloroprocaine and Clonidine. J Pain Res. 2020;13:2749-2755.
22. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anaesthesia in children: a one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists. Anaesth Analg 1996; 83:904 912.
23. Suresh, Santhanam MD*; Long, Justin MD*; Birmingham, Patrick K. MD*; De Oliveira, Gildasio S. Jr MD, MSCI† Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database, Anaesth Analg. 2015< 120 151-156.
24. Breschan C, Krumpholz R, Jost R, Likar R. Intraspinal haematoma following lumbar epidural anaesthesia in a neonate. Paediatr Anaesth 2001; 11:105 –108.
25. Apthorp M, Challands J, Visram A. A survey of the usage of caudal catheters amongst paediatric anaesthetists practising in the UK [Abstract]. Paediatr Anaesth 2000; 10:692.
26. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg. 2012;115(3):638-662. )
27. Lejus C, Surbled M, Schwoerer D, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Paediatr Anaesth 2001; 11:327-332.
28. Breschan C, Krumpholz R, Likar R, et al. Can a dose of 2 mg kg71 caudal clonidine cause respiratory depression in neonates? Paediatr Anaesth 1999; 9:81-83.
29. Bouchut JC, Dubois R, Godard J. Clonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea. Reg Anesth Pain Med 2001; 26:83-85.
30. Wood CE, Goresky GV, Klassen KA, et al. Complications of continuous epidural infusions for postoperative analgesia in children. Can J Anaesth 1994; 41:613-620.
31. Boos K, Beushausen T, Ohrdorf W. Peridural catheter for postoperative long- term analgesia in children. AnaÈ sthesiol Intensivmed Notfallmed Schmerzther 1996; 31:362-367.
32. Aram L, Krane EJ, Kozloski LJ, Yaster M. Tunneled epidural catheters for prolonged analgesia in pediatric patients. Anesth Analg 2001; 92:1432- 1438.
33. Fujinaka W, Hinomoto N, Saeki S, et al. Decreased risk of catheter infection in infants and children using subcutaneous tunneling for continuous caudal anesthesia. Acta Med Okayama 2001; 55:283-287.
34. Vas L, Naik V, Patil B, Sanzgiri S. Tunnelling of caudal epidural catheters in infants. Paediatr Anaesth 2000; 10:149-154.
35. Bubeck J, Boos K, Krause H, Thies K. Subcutaneous Tunneling of Caudal Catheters Reduces the Rate of Bacterial Colonization to That of Lumbar Epidural Catheters. Anesthesia & Analgesia. 2004;99:689-693.
36. Kinirons B, Mimoz O, Lafendi L, et al. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anaesthesiology 2001; 94:239-244.
37. BuÈttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 2000; 10:303-318.
38. Lejus C, Surbled M, Schwoerer D, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Paediatr Anaesth 2001; 11:327-332.
39 Joselyn A,Bhalla T, Schloss B, Martin D,Tobias J.A case report of a retained and knotted caudal epidural catheter.Saudi J Anaesth 2014;8:424.
| How to Cite this Article: Ponde V, Puri K, Dave N | Continuous Caudal Catheters in Neonatal Population: A Focussed Review | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 124-130.
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Changing Scenario of Regional Anaesthesia Practice in Northeast India
Vol 2 | Issue 2 | July-December 2021 | Page 117-123 | Himjyoti Das, Surajit Giri, Langpoklakpam Chaoba Singh
DOI: 10.13107/ijra.2021.v02i02.039
Authors: Himjyoti Das [1], Surajit Giri [2], Langpoklakpam Chaoba Singh [3]
[1] Department of Anaesthesia & Critical care, Nazareth Hospital, Shillong, Meghalaya.
[2] Department of Anaesthesia, Pragati Hospital & Research Centre, Sivasagar, Assam.
[3] Department of Anaesthesia & Critical care, RIMS, Imphal, Manipur.
Address of Correspondence
Dr. Surajit Giri,
Pragati Hospital & Research Centre, Sivasagar, Assam.
E-mail: drsurajitgiri@outlook.com
Abstract
The North-East (NE) region of India comprises of eight states- Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura. (Fig 1) The anesthesia services in remote areas of this region are greatly restricted due to inadequate qualified manpower and infrastructure, as very few postgraduate and DNB (Diplomate National Board) seats are available each year across 4 out of 8 states through the NEET PG Test. (Fig 2a & 2b) Regional Anesthesia (RA) has several benefits in certain patients over general anesthesia. It not only allows for better post-operative pain management and a comfortable post-operative patient, but also allows for safer surgeries in patients with comorbidities that carry potentially life-threatening risks with general anesthesia, especially in a resource limited areas. The practice of RA took a backseat in the recent past due to lack of proper training in RA and the absence of a structured curriculum during PG training. However, during the last decade, we have witnessed a paradigm shift in RA and PNB (Peripheral nerve block) anesthesia with continued support from Academy of Regional Anaesthesia (AORA) & Indian Society of Anesthesiologists (ISA). For better understanding of the changing scenario of regional anesthesia practice in this region over years, we may divide the timeline into two phases, late 20th century and the 21st century.
| How to Cite this Article: Das H, Giri S, Singh LC | Changing Scenario of Regional Anaesthesia Practice in Northeast India | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 117-123. |
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The Anatomy Table – Is it the Future Learning Tool for Regional Anaesthesiologists?
Vol 2 | Issue 2 | July-December 2021 | Page 111-116 | Rajkumar Elanjeran, Anitha Ramkumar, Sandeep Ganni
DOI: 10.13107/ijra.2021.v02i02.038
Authors: Rajkumar Elanjeran [1], Anitha Ramkumar [1], Sandeep Ganni [2]
[1] Department of Emergency Medicine, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India.
[2] Managing Director, GSL Educational Society, Rajahmundry, Andhra Pradesh, India.
Address of Correspondence
Dr. Rajkumar Elanjeran
Manager, Clinical Lead of Simulation, and Consultant Emergency Physician, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India.
E-mail: seran50.raj@gmail.com
Abstract
Cadaveric dissection has been the main stay of anatomy training for regional anaesthesia over the years. Advent of advance visualisation hardware and software has revolutionised anatomy teaching and it is only a matter of time before this technology transcends into regional anaesthesia training. This article demonstrates the innumerable capabilities of virtual dissection table using one specific use case- the supraclavicular approach to the brachial plexus block.
Keywords: Simulation, Virtual dissection, Virtual anatomy
References
1. Fyfe, Sue & Fyfe, Georgina & Dye, Danielle & Radley-Crabb, Hannah. (2018). The Anatomage table: Differences in student ratings of usefulness from first implementation to established use.
2. Alessandro Stecco, Francesca Boccafoschi, Zeno Falaschi, Giulio Mazzucca, Andrea Carisio, Simone Bor, Irene Valente, Sergio Cavalieri, Alessandro Carriero,. Virtual dissection table in diagnosis and classification of Le Fort fractures: A retrospective study of feasibility, Translational Research in Anatomy, Volume 18, 2020, 100060.
3. Taoum, Alexandre & Sadqi, Rihab & Zidi, Mustapha & Tassigny, Alexandra & Megdiche, Kawtar & Ngote, Nabil. (2019). On the Use of Anatomage Table as Diagnostic Tool. 13. 20-25.
4. J. Brown, S. Stonelake, W. Anderson, M. Abdulla, C. Toms, A. Farfus, J. Wilton, Medical student perception of anatomage – A 3D interactive anatomy dissection table, International Journal of Surgery, Volume 23, supplement 1, 2015, Pages S17-S18.
5. Smith, K.E., Ruholl, H.O. and Gopalan, C. (2019), Utilization of Anatomage Table Technology Enhances Knowledge, Comprehension, and Application of Human Anatomy and Physiology in Multiple Settings. The FASEB Journal, 33: 598.19-598.19.
| How to Cite this Article: Elanjeran R, Ramkumar A, Ganni S | The Anatomy Table – Is it the Future Learning Tool for Regional Anaesthesiologists? | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 111-116. |
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Randomized Controlled Trials
Vol 2 | Issue 2 | July-December 2021 | Page 107-110 | Nidhi Bhatia, Anju Grewal
DOI: 10.13107/ijra.2021.v02i02.037
Authors: Nidhi Bhatia [1], Anju Grewal [2]
[1] Department of Anaesthesiology & Intensive Care, PGIMER, Chandigarh, India.
[2] Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Address of Correspondence
Dr. Anju Grewal, Professor & Head,
Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
E-mail: dranjugrewal@gmail.com
Abstract
A randomized controlled trial (RCT) is a prospective, comparative, quantitative experiment/study that is performed under controlled conditions with random allocation of interventions to comparison groups. Among all the clinical study designs, evidence generated from RCTs is considered to be at top of the evidence pyramid. There are many different RCT designs and they can be classified on the basis of interventions evaluated, participants’ exposure and level of blinding. All RCTs should be planned prospectively, a research question should be formulated, sample population approached and informed consent obtained from participants of the trial. These consented subjects are randomly assigned to any of the study arms and the changes are then measured over time. The basic principles to designing an RCT include formulating a research question, developing a protocol, randomization, allocation concealment, blinding, sample size calculation and registering of RCTs. Appropriate guidelines for reporting RCTs should be followed and RCTs should only be conducted if they are ethically viable, economical and clinically worthwhile.
Keywords: Randomised Control Trial (RCT)
References
1. Zabor EC, Kaizer AM, Hobbs BP. Randomized Controlled Trials. Chest 2020; 158: S79-S87.
2. Bhide A, Shah PS, Acharya G. A simplified guide to randomized controlled trials. Acta Obstet Gynecol Scand 2018;97:380-387.
3. White H, Sabarwal S, De Hoop T. Randomized Controlled Trials (RCTs): Methodological Briefs 2014 ; Impact Evaluation No. 7, Methodological Briefs no. 7.
4. Stolberg HO, Norman G, Trop I. Randomized controlled trials. AJR Am J Roentgenol 2004;183:1539-44.
5. Thiruvenkatachari B. Randomized controlled trials: The technique and challenges. J Indian Orthod Soc 2015;49:42-7.
6. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191–2194. doi:10.1001/jama.2013.281053.
7. Elliott TR. Registering randomized clinical trials and the case for CONSORT. Exp Clin Psychopharmacol. 2007 Dec;15(6):511-8. doi: 10.1037/1064-1297.15.6.511. PMID: 18179303; PMCID: PMC2518067.
8. Akobeng AK. Understanding randomised controlled trials. Arch Dis Child 2005 ;90:840-4.
| How to Cite this Article: Bhatia N, Grewal A | Randomized Controlled Trials | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 107-110. |
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Anatomy of Lumbar Plexus and Implications to Regional Anaesthesiologist
Vol 2 | Issue 2 | July-December 2021 | Page 102-106 | G. Amudha, Sandeep Diwan
DOI: 10.13107/ijra.2021.v02i02.036
Authors: G. Amudha [1], Sandeep Diwan [2]
[1] Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
[2] Department of Anaesthesia, Sancheti Hospital Pune, Maharashtra, India.
Address of Correspondence
Dr. G.Amudha,
Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore, India
E-mail: ammuramesh@gmail.com
Abstract
Lumbar plexus is one of the two nerve plexuses which supply the lower limb. It is formed in the posterior abdominal wall within the psoas major muscle. The branches of the plexus exit via the medial and lateral borders as well as its ventral surface. It is a complex plexus which gives a branch to complete the formation of lumbo sacral plexus. The branches mainly supply the groin, anterior and medial compartments of thigh. They also supply the hip and knee joints. The cutaneous innervation by the branches of lumbar plexus is limited to the anterior, lateral and medial parts of the thigh, medial side of the leg and foot and also the lower part of anterior abdominal wall and perineum. Regional anaesthesia is a highly skilled and precise technique used widely in the patients to reduce the drug usage and decrease the intra and post operative complications. Lumbar plexus block can be used in surgeries related to hip joint and anterior part of thigh and groin. To execute the procedure successfully, sound knowledge in anatomy of lumbar plexus is required.
Keywords: Lumbar plexus, Branches, Regional anaesthesia.
References
1. Standring S. Gray’s Anatomy: The anatomical Basis of Clinical Practice. In pelvic girdle, gluteal region and thigh:41st edition: London. Elsevier; 2015; 1371-73.
2. Mahakkanukrauh P et al. A cadaveric study of the anatomical variations of the lumbar plexus with clinical implications. J.Anat. Soc. India, 2016;65:24-8.
3. Javier J. Polania Gutierrez; Bruce Ben-David .2020. Lumbar plexus block. https://www.ncbi.nlm.nih.gov/books/NBK556116.
4. Philip A Anloague, Peter Hujibregts. Anatomical variations of the lumbar plexus: A descriptive anatomy study with proposed clinical implications. The J. Man. Manip.Ther. 2009;17(4): e107-e114.
5. Deepti Arora, Subhash Kaushal, Gurbachan Singh. Variations of lumbar plexus in 30 adult human cadavers – A unilateral prefixed plexus. Int. J. Plant, Animal and Environmental sciences. 2014; 4: 225 – 28.
6. Prof.Gamal S Desouki et al. Study of anatomical pattern of lumbar plexus in human (cadaveric study). Az.J.Pharm Sci. 2016; 54:54-69.
7. Dr.Fasila P. Asis, Dr.Priya Ranganath. A Human cadaveric study on variations in formation and branching pattern of lumbar plexus with its clinical implications.Sch.J of App. Med. Sci.2017;58-63.
8. Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging. Eur. J Med 2020; 52(1): 16-20.
9. Chayen D, Nathan H, Chayen M. The psoas compartment block. Anesthesiology. 1976 Jul; 45(1):95-9.
| How to Cite this Article: Amudha G, Diwan S | Anatomy of Lumbar Plexus and Implications to Regional Anaesthesiologist | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 102-106. |
