Résumé
L'objectif habituel d'un bloc du plexus lombaire est de bloquer simultanément les trois nerfs destinès à la partie proximale du membre inférieur (nerfs fémoral, obturateur et cutané latéral de cuisse) et l'approche la plus utilisée est celle décrite parWinnie (inguinale paravasculaire). Plusieurs études montrent que cet objectif est difficile à attaindre par cette méthode tandis que d'autres travaux amènent à reconsidérer l'intérêt des approaches directes (paravertébrales) du plexus lombaire malgré le risque de diffusion péridurale. Des cathéters permettent de réduire les risques, de prolonger et de moduler l'effet. L'indication principale de ces techniques est l'analgésie post-opératoire mais d'autres utilisations sont proposées (analgésie chirurgicale, analgésie pour rééducation...).
Summary
The technique described byWinnie is supposed to provide a regional block of the femoral, femoral cutaneous, and obturaror nerves by a single injection; it is considered as a blockade of the lumbar plexus but it should not be expected to block the obturator nerve. Although the posterior approaches to the lumbar plexus are likely to result in superior lumbar plexus anaesthesia, they may be associated with inadvertent extradural block. Insertion of a catheter into the femoral nerve sheath or into the psoas compartment may reduce the risks and provides continuous analgesia. Lumbar plexus block is mainly used for reduction of postoperative pain but it may also be used for surgical analgesia or for analgesia during mobilisation.
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Adam, J.F. Blocs du plexus lombaire. Doul. et Analg. 10, 161–163 (1997). https://doi.org/10.1007/BF03003152
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DOI: https://doi.org/10.1007/BF03003152