Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine

  • Juliana Farny
  • Michel Girard
  • Pierre Drolet
Reports of Investigation

Abstract

A combination of lumbar plexus block, by a posterior technique, and sciatic nerve block can be a useful technique for outpatient anaesthesia. The purpose of this study was to examine the clinical characteristics of these blocks using lidocaine and to measure the serum lidocaine concentrations. Forty-five patients, undergoing lower extremity surgery, were studied. Sciatic nerve and lumbar plexus blocks were made with lidocaine, 680 mg with adrenaline 0.3 mg. For each patient the following data were collected: weight, age, sex, site of surgery, time to perform each block, needle depth, speed of onset of the sensory and motor blocks in the territories of the sciatic, femoral, obturator and lateral cutaneous (sensory) nerves and postoperative analgesic requirements. Lidocaine serum concentrations were measured in ten of these patients at 0, 2, 5, 10, 30, 60, 90 and 120 min after the second block. Analgesia was complete in 88% (40/45) of the patients. The remaining five patients needed analgesics (fentanyl 150 μg or less). Despite the high dose of lidocaine, the serum concentrations were within safe limits (mean ± SD) (CMAX = 3.66 ± 2.21 μg · ml−1). Only one patient had a serum concentration > 5 μg · ml−1 (CMAX = 9.54 μg · ml−1). This was associated with a contra-lateral extension of the block. We conclude that this combination of blocks is a valuable alternative for unilateral lower extremity anaesthesia. However, clinicians must be aware of the implications of a contra-lateral extension of the block.

Key words

anaesthetic techniques: regional, lumbar plexus block, sciatic nerve block anaesthetics: local, lidocaine 

Résumé

Le bloc du plexus lombaire, par voie postérieure, combiné au bloc du nerf sciatique, peut être utile en chirurgie d’un jour. Le but de ce travail est d’étudier les caractéristiques cliniques de cette combinaison de blocs en utilisant la lidocaïne et de mesurer les taux sériques de lidocaïne. Quarante-cinq patients qui ont subi une chirurgie du membre inférieur en utilisant cette technique anesthésique ont été étudiés. Des blocs du nerf sciatique et du plexus lombaire ont été faits à l’aide de 680 mg de lidocaïne adrénalisée (0.3 mg). Pour chaque patient les données suivantes ont été recueuillies: poids, âge, sexe, site de l’intervention, temps pour faire les blocs, profondeur des nerfs, temps d’installation des blocs moteurs et sensitifs dans les territoires des nerfs sciatique, fémoral, obturateur et fémoro-culané (sensitif) et les besoins postopératoires en analgésiques. Les taux sériques de lidocaïne ont été mesurés chez dix de ces patients à 0, 2, 5, 10, 30, 60, 90 et 120 min après le deuxième bloc. Dans 88% des cas (40/45) le bloc était complet. Les autres patients ont nécessité l’emploi d’analgésiques (fentanyl < - 150 μg). Malgré la dose élevée de lidocaïne employée, les taux sériques mesurés étaient dans les limites acceptables (CMAX = 3,66 ± 2,21 μg · ml−1). Un seul patient a présenté des valeurs dépassant 5 μg · ml−1(Cmax = 9,54 μg · ml−1) associées à un débordement controlatéral du bloc. Nous concluons que l’association des blocs du plexus lombaire et du nerf sciatique constitue une alternative acceptable pour l’anesthésie du membre inférieur. Une attention particulière doit cependant être accordée aux patients où la distribution du bloc est bilatérale.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Juliana Farny
    • 2
  • Michel Girard
    • 1
  • Pierre Drolet
    • 1
  1. 1.Département d’anesthésie-réanimationHôpital Maisonneuve-Rosemont et Université de MontréalMontréal
  2. 2.CHRU de StrasbourgFrance

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