| Lumbar plexus block using high-pressure injection leads to contralateral and epidural spread. | |
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MedLine Citation:
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PMID: 18813048 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The main advantage of lumbar plexus block over neuraxial anesthesia is unilateral blockade; however, the relatively common occurrence of bilateral spread (up to 27%) makes this advantage unpredictable. The authors hypothesized that high injection pressures during lumbar plexus block carry a higher risk of bilateral or neuraxial anesthesia. METHODS: Eighty patients undergoing knee arthroscopy (age 18-65 yr; American Society of Anesthesiologists physical status I or II) during a standard, nerve stimulator-guided lumbar plexus block using 35 ml mepivacaine, 1.5%, were scheduled to be studied. Patients were randomly assigned to receive either a low-pressure (< 15 psi) or a high-pressure (> 20 psi) injection, as assessed by an inline injection pressure monitor (BSmart; Concert Medical LLC, Norwell, MA). The block success rate and the presence of bilateral sensory and/or motor blockade were assessed. RESULTS: An interim analysis was performed at n = 20 after an unexpectedly high number of patients had neuraxial spread, necessitating early termination of the study. Five of 10 patients (50%) in the high-pressure group had a neuraxial block with a dermatomal sensory level T10 or higher. In contrast, no patient in the low-pressure group (n = 10) had evidence of neuraxial spread. Moreover, 6 patients (60%) in the high-pressure group demonstrated bilateral sensory blockade in the femoral distribution, whereas no patient in the low-pressure group had evidence of a bilateral femoral block. CONCLUSIONS: Injection of local anesthetic with high injection pressure (> 20 psi) during lumbar plexus block commonly results in unwanted bilateral blockade and is associated with high risk of neuraxial blockade. |
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Authors:
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Jeff C Gadsden; Danielle M Lindenmuth; Admir Hadzic; Daquan Xu; Lakshmanasamy Somasundarum; Kamil A Flisinski |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesiology Volume: 109 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-24 Completed Date: 2008-10-07 Revised Date: 2009-04-23 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 683-8 Citation Subset: AIM; IM |
Affiliation:
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Columbia University College of Physicians and Surgeons, New York, New York, USA. jeffgadsden@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Female Humans Lumbar Vertebrae* Male Mepivacaine / administration & dosage, pharmacokinetics Middle Aged Nerve Block / methods* Pressure |
| Chemical | |
Reg. No./Substance:
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96-88-8/Mepivacaine |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2009 May;110(5):1196; author reply 1197
[PMID:
19387193
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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