| Research background and objective:Lumbar plexus(LP)are made by T12,L1-3 Lumbar nerve root which cross intervertebral foramen and downward through the psoas major.The nerve plexus mainly control the skin of lateral thigh(lateral cutaneous nerve),the skin in front of knee(femoral nerve),and the skin of interior thigh(obturator nerve).Lumbar plexus block(LPB)is to inject local anesthetics around the root to block the sense of front,medial and lateral thigh.Lumbar plexus block plays an important role in unilateral lower limb selective anesthesia or analgesia.Short axis in-plane lumbar plexus block guided by ultrasound has been shown to provide a safe and effective anesthesia for patients who accept unilateral arthroscopic surgery.Regional block anesthesia guided by ultrasound is a more precise approaches to choose.Lumbar plexus are in the deep trunk,which needs real-time visual process and unobstructed approach to avoid inject the anesthetic into intervertebral foramen and spinal.Double guiding(guide by stimulator and ultrasound)has many advantages.Ultrasound shows the location of puncture needle.Peripheral nerve stimulator show indirectly whether intrathecal injection occurs.Most superficial nerve block can be guided by high frequency transducer.However,lumbar plexus is located in the deep of trunk and the puncture point is very limited,so the imaging may not be very clear.Therefore,combining with the use of the stimulator can greatly improve the safety and effectiveness.But traditional operation is not easy,there is no article show which method is more suitable for the ultrasound.In short axis in-plane method,the probe locate at the center of the back line,transverse proces cause the rear anechoic area where lumbar plexus nerve root and intervertebral foramen are located in this area.If still we use posterior approach which is not real-time visual,the organ damage can not be reduced.We learn from the shamrock method,developed an novel method of lumbar plexus block technology-“beach chair” method.We put probe at the lateral side of the abdomen.Transverse process and the lateral limbus vertebral bodies formed a hyperechoic signal which similar "beach chair".Puncture in plane,advance to the "rainbow" hyperechoic signal.Methods:60 patients who underwent unilateral knee arthroscopy surgery were randomly divided into beach chair method group and short axis in-plane method group.Main target is testing bilateral sensory,motor block rate and incidence of epidural block at 5 minutes,15 minutes,30 minutes after block.The secondary targets include image positioning time,number of puncture,puncture time,the sensory and the knee joint movement block time,complications.All relevant data collected by blind observers.Results:60 cases unilateral the arthroscopic surgery patients were randomly divided into beach chair method group and short axis in-plane method group.In this study,the general data of two groups of patients have no statistical difference.At 5 min,15 min,30 min after lumbar plexus block,the average heart rate and blood pressure have no statistical difference in both groups.5 min,15 min,30 min after lumbar plexus block two groups of sensory and motor block rate was no significant difference.There is no difference between two groups in the contralateral sensory and motor block rate at 5 min,but the contralateral sensory and knee joint motion block rate of beach chair method was lower than that in short axis in-plane method group,respectively(1 case(3.3%)VS 9 cases(30.0%),P = 0.006).For Incidence of epidural block,beach chair method group was lower than that in short axis in-plane method group,respectively(1 case(3.3%)VS 9 cases(30.0%),P = 0.006).Image positioning time of beach chair method group was obviously less than short axis in-plane method group,respectively(34.2 seconds;95% CI,[28.2-40.2] versus 48.9 seconds;95% CI,[42.9-54.9],P = 0.001).Ultrasound visibility score between the two groups have significant difference,P = 0.000.For Puncture time,beach chair method is significantly less than the short axis in-plane method group,respectively(85.0 seconds;95% CI,[ 68.8-101.2] versus 131.4 seconds;95% CI,[99.8-162.9],P = 0.013).For the number of Puncture,beach chair method significantly less than the short axis in-plane method group,respectively(2.7±1.3 vs 4.5±2.1,P = 0.000).We found no obvious difference between the rest of the indicators.Conclusions:For Puncture time,Ultrasound visibility score and the number of puncture,Beach chair method group was obviously less than short axis in-plane method group.Beach chair method can provide the same feelings to patient and the same block effect of knee joint movement with short axis in-plane method,it also can reduce the incidence of epidural block.So Beach chair method double-guide lumbar plexus block is a good choice. |
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