Abstract
We report two cases of plantar flexion due to epidural misplacement of the needle during psoas compartment block, providing a response feedback for needle position during this procedure. In one case, the response occurred contralaterally, and in the other bilaterally. In the first patient, the cause of contralateral plantar flexion could not be determined and no injection was made. In the second patient, the anteriorposterior-fluoroscopic image showed that the tip of the needle was placed at the midline of the column. At this point, 3 ml of radiopaque medium was injected, and it diffused throughout the epidural space. Subsequently, single-shot epidural anesthesia was achieved by injection through this needle.
Similar content being viewed by others
References
Ozalp G, Kaya M, Tuncel G, Canoler O, Gulnerman G, Savli S, Kadiogullari N. The analgesic efficacy of two different approaches to the lumbar plexus for patient-controlled analgesia after total knee replacement. J Anesth. 2007;21:409–412.
Gentili M, Aveline C, Bonnet F. Total spinal anaesthesia complicating posterior lumbar plexus block. Ann Fr Anesth Reanim. 1998;17:740–742.
De Biasi P, Lupescu R, Burgun G, Lascurain P, Gaertner E. Continuous lumbar plexus block: use of radiography to determine catheter tip location. Reg Anesth Pain Med. 2003;28:135–139.
Pousman RM, Mansoop Z, Sciard D. Total spinal anesthetic after continuous posterior lumbar plexus block. Anesthesiology. 2003;98:1281–1282.
Litz RJ, Vicent O, Wiessner D, Heller AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med. 2004;29:60–64.
Pandin PC, Vandesteene A, d’Hollander AA. Lumbar plexus posterior approach: a catheter placement description using electrical nerve stimulation. Anesth Analg. 2002;95:1428–14231.
Chayen D, Nathan H, Chayen M. Lumbar plexus: a new posterior approach. Anesthesiology. 1973;45:95–99.
Meier G, Buettner J. Peripheral regional anesthesia. Stuttgart: Thieme; 2006.
Tsui BC, Gupta S, Finucane B. Confirmation of epidural catheter placement using nerve stimulation. Can J Anaesth. 1998;45:640–644.
Tsui BC, Seal R, Koller J, Entwistle L, Haugen R, Kearney R. Thoracic epidural analgesia via the caudal approach in pediatric patients undergoing fundoplication using nerve stimulation guidance. Anesth Analg. 2001;93:1152–1155.
Tsui BC, Wagner AM, Cunnungham K, Perry S, Deasai S, Seal R. Can continuous low current electrical stimulation distinguish insulated needle position in the epidural and intrathecal spaces in pediatric patients? Paedriatr Anaesth. 2005;15:959–963.
Stone RG, Weeks LE, Hajdu M, Stinchfield FE. Evaluation of sciatic nerve compromise during total hip arthroplasty. Clin Orthop. 1985;201:26–31.
Ben-David B, Joshi R, Chelly JE. Sciatic nerve palsy after total hip arthroplasty in a patient receiving continuous lumbar plexus block. Anesth Analg. 2003;97:1180–1182.
Ozalp G, Canoler O, Tuncel G, Turgut S, Kadiogullari N. Sciatic nerve palsy after total hip arthroplasty in a patient receiving psoas compartment block for patient-controlled regional analgesia. J Anesth. 2006;20:251–252.
Author information
Authors and Affiliations
About this article
Cite this article
Cesur, M., Alici, H.A. & Erdem, A.F. A plantar flexion response to nerve stimulation indicates needle misplacement in the epidural/spinal space during psoas compartment block. J Anesth 23, 139–142 (2009). https://doi.org/10.1007/s00540-008-0689-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-008-0689-0