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

Gianluca Cappelleri, Giorgio Aldegheri, Francesco Ruggieri, Franco Carnelli, Andrea Fanelli, Andrea Casati

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 languageEnglish
Pages (from-to)10-16
Number of pages7
JournalRegional Anesthesia and Pain Medicine
Volume33
Issue number1
DOIs
Publication statusPublished - Jan 2008

Fingerprint

Lumbosacral Plexus
Mepivacaine
Femoral Nerve
Anesthetics
Thigh
Obturator Nerve
Confidence Intervals
Skin
Nerve Block
Anterior Cruciate Ligament
Analgesics
Anesthesia

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 journalArticle

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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.",
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AU - Cappelleri, Gianluca

AU - Aldegheri, Giorgio

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AU - Fanelli, Andrea

AU - Casati, Andrea

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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.

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