Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients
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Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients
Journal of Third Military Medical UniversityVol. 41, Issue 8, Pages: 810-814(2019)
作者机构:
400038 重庆,陆军军医大学(第三军医大学)第一附属医院麻醉科Department of Anesthesiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
Xuhao ZHANG, Wenquan HE, Xinrong WEN, et al. Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients[J]. Journal of Third Military Medical University, 2019, 41(8): 810-814.
DOI:
Xuhao ZHANG, Wenquan HE, Xinrong WEN, et al. Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients[J]. Journal of Third Military Medical University, 2019, 41(8): 810-814. DOI: 10.16016/j.1000-5404.201901129.
Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients
To assess the efficacy of ultrasound combined with neurostimulation for improving the success rate of lumbar plexus block in obese patients undergoing lower extremity surgeries.
Methods
2
We randomized 80 obese patients undergoing lower limb surgeries under lumbar plexus block anesthesia between June
2016 and June
2018 into 2 equal groups
in which lumbar plexus block was performed under ultrasound localization (U group) or ultrasound combined with neurostimulation localization (UN group). The findings by ultrasound imaging and the success rate of lumbar plexus were compared between the 2 groups.
Results
2
All the 80 patients completed the study. In the U group
the ultrasound visibility score was 11 (range 6-15)
and the lumbar plexus was seen in 26 patients; The ultrasound visibility score of the UN group was 11 (5-15)
and the lumbar plexus was observed in 23 patients
showing no significant differences between the two groups (
P
>
0.05). In the U group
lumbar plexus block was achieved successfully in 31 cases and failure occurred in 9 cases; successful block was achieved in 38 cases and failure occurred in 2 cases in the UN group
demonstrating a significantly higher success rate in the latter group (
P
<
0.05).
Conclusion
2
Ultrasound combined with neurostimulation can improve the success rate of lumbar plexus block in obese patients.
NI G H, ZHANG J, ZHENG F T. Status and trends of chinese obesity epidemic. food and nutrition in China[J]. Food Nutr China, 2013, 19(10): 70-74. DOI: 10.3969/j.issn.1006-9577.2013.10.018.
BRODSKY J B, MARIANO E R. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance[J]. Best Pract Res Clin Anaesthesiol, 2011, 25(1): 61-72.
INGRANDE J, BRODSKY J B, LEMMENS H J.Regional anesthesia and obesity[J]. Curr Opin Anaesthesiol, 2009, 22(5): 683-686. DOI: 10.1097/ACO.0b013e32832eb7bd.
WADHWA A, KANDADAI S K, TONGPRESERT S, et al . Ultrasound guidance for deep peripheral nerve blocks: A brief review[J ] . Anesthesiol Res Pract, 2011, 2011: 262070. DOI: 10.1155/2011/262070.
LIU S S, NGEOW J, JOHN R S. Evidence basis for ultrasound-guided block characteristics: onset, quality, and duration[J]. Reg Anesth Pain Med, 2010, 35(2 Suppl): S26-S35. DOI: 10.1097/AAP.0b013e3181d266f0.
LEWIS S R, PRICE A, WALKER K J, et al . Ultrasound guidance for upper and lower limb blocks[J ] . Cochrane Database Syst Rev, 2015(9): CD006459. DOI: 10.1002/14651858.CD006459.pub3.
KARMAKAR M K, LI J W, KWOK W H, et al . Ultrasound-guided lumbar plexus block using a transverse scan through the lumbarintertransverse space: A prospective case series[J ] . Reg Anesth Pain Med, 2015, 40(1): 75-81. DOI: 10.1097/AAP.0000000000000168.
LIN J A, LEE Y J, LU H T. Finding the bulging edge: A modified shamrock lumbar plexus block in average-weight patients[J]. Br J Anaesth, 2014, 113(4): 718-720. DOI: 10.1093/bja/aeu330.
KARMAKAR M K, HO A M H, LI X, et al . Ultrasound-guided lumbar plexus block through the acoustic window of the lumbar ultrasound trident[J ] . Brit J Anaesth, 2008, 100(4): 533-537. DOI: 10.1093/bja/aen026.
SAUTER A R. The "Shamrock Method" - a new and promising technique for ultrasound guided lumbar plexusblocks[J]. Brit J Anaesth, 2013, 111(eLetters). DOI: 10.1093/bja/el_9814.
ARNUNTASUPAKUL V, CHALACHEWA T, LEURCHARUSMEE P, et al . Ultrasound withneurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial[J ] . Eur J Anaesthesiol, 2018, 35(3): 224-230. DOI: 10.1097/EJA.0000000000000736.
ILFELD B M, LOLAND V J, MARIANO E R.Prepuncture ultrasound imaging to predict transverse process and lumbar plexus depth for psoas compartment block and perineural catheter insertion: A prospective, observational study[J]. Anesth Analg, 2010, 110(6): 1725-1728. DOI: 10.1213/ANE.0b013e3181db7ad3.
NIELSEN K C, GULLER U, STEELE S M, et al . Influence of obesity on surgical regional anesthesia in the ambulatory setting: An analysis of 9, 038 blocks[J ] . Anesthesiology, 2005, 102(1): 181-187.
LYU R, CHEN Y, ZENG J, et al .Shamrock versus short-axis in-plane ultrasound guided methods in visualization of lumbar plexus block[J ] . J Third Mil Med Univ, 2016, 38(15): 1777-1780. DOI: 10.16016/j.1000-5404.201602009.
DELAUNAY L, BLOC S. Is nerve stimulation still necessary in ultrasound-guided regional anaesthesia[J]. Ann Fr Anesth Reanim, 2012, 31(9): e199-e201. DOI: 10.1016/j.annfar.2012.06.017.
FIELMUTH S, SZALATA M, SIEVERT H, et al . Electric nerve stimulation does not correctly predict needle-nerve distance and po tential local anesthetic spread forinter scalene brachial plexus blockade[J ] . Anesth Analg, 2017, 125(2): 632-634. DOI: 10.1213/ANE.0000000000001982.
SAUTERA R, ULLENSVANG K, NIEMI G, et al . The Shamrock lumbar plexus block: A dose-finding study[J ] . Eur J Anaesthesiol, 2015, 32(11): 764-770. DOI: 10.1097/EJA.0000000000000265.