Abstract
Background and Objectives: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. Methods: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). Results: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED50) was 1.06% ± 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% ± 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). Conclusions: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.
| Original language | English |
|---|---|
| Pages (from-to) | 10-16 |
| Number of pages | 7 |
| Journal | Regional Anesthesia and Pain Medicine |
| Volume | 33 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2008 |
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Keywords
- Anterior 3-in-1
- Anterior cruciate ligament repair
- Lumbar plexus block
- Mepivacaine
- Minimum effective concentration
- Posterior psoas compartment
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
Cite this
Effects of Using the Posterior or Anterior Approaches to the Lumbar Plexus on the Minimum Effective Anesthetic Concentration (MEAC) of Mepivacaine Required to Block the Femoral Nerve : A Prospective, Randomized, Up-and-Down Study. / Cappelleri, Gianluca; Aldegheri, Giorgio; Ruggieri, Francesco; Carnelli, Franco; Fanelli, Andrea; Casati, Andrea.
In: Regional Anesthesia and Pain Medicine, Vol. 33, No. 1, 01.2008, p. 10-16.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effects of Using the Posterior or Anterior Approaches to the Lumbar Plexus on the Minimum Effective Anesthetic Concentration (MEAC) of Mepivacaine Required to Block the Femoral Nerve
T2 - A Prospective, Randomized, Up-and-Down Study
AU - Cappelleri, Gianluca
AU - Aldegheri, Giorgio
AU - Ruggieri, Francesco
AU - Carnelli, Franco
AU - Fanelli, Andrea
AU - Casati, Andrea
PY - 2008/1
Y1 - 2008/1
N2 - Background and Objectives: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. Methods: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). Results: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED50) was 1.06% ± 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% ± 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). Conclusions: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.
AB - Background and Objectives: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. Methods: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). Results: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED50) was 1.06% ± 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% ± 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). Conclusions: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.
KW - Anterior 3-in-1
KW - Anterior cruciate ligament repair
KW - Lumbar plexus block
KW - Mepivacaine
KW - Minimum effective concentration
KW - Posterior psoas compartment
UR - http://www.scopus.com/inward/record.url?scp=37249002888&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=37249002888&partnerID=8YFLogxK
U2 - 10.1016/j.rapm.2007.07.008
DO - 10.1016/j.rapm.2007.07.008
M3 - Article
C2 - 18155051
AN - SCOPUS:37249002888
VL - 33
SP - 10
EP - 16
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
SN - 1098-7339
IS - 1
ER -