Document Detail

Soft Tissue Depression At The Iliac Crest Prominence: A New Landmark For Identifying The L4-L5 Interspace.
MedLine Citation:
PMID:  22772854     Owner:  NLM     Status:  Publisher    
BACKGRUND: One of the most common approaches to identifying the L4-L5 interspace is using the iliac crest as a landmark. We propose a new landmark to identify the L4-L5 interspace based on the soft tissue depression palpable at the iliac crest prominence. The aim of this study was to assess the reliability and time saving when using this new landmark compared to using the iliac crest to perform a lumbar plexus block. METHODS: 54 patients scheduled for lower limb surgery were randomly allocated to have a lumbar plexus block performed using the iliac crest (Chayen approach) or the soft tissue depression (Borghi approach). The landmarks for both approaches were drawn on each patient prior to randomization (n=27 per group). All the blocks were performed by an anesthesiologist familiar with both techniques using a nerve stimulator and 30 ml of 0.5% levobupivacaine. The time to achieve successful needle placement and the number of needle re-directions, as well as the onset time for the sensory and motor blockade, were recorded. RESULTS: All the blocks using Borghi's approach were performed successfully. With the Chayen approach, there were 5 needle placement failures. The mean times to onset of a successful block after injection of the local anesthetic did not differ between the two groups: 17.8 (±3.9 SD) min for the Chayen vs. 15.9 (±2.4 SD) min for the Borghi approach (p=0.14). However, the mean time to achieve correct needle placement was 7.6 (±3.2 SD) min with the Chayen approach compared to 5.1 (±2.6 SD) min with the Borghi approach (p<0.01). The Chayen approach also required a significantly higher median number of needle redirections (2 [inter-quartile range (IQR): 0-4] vs. 0 [IQR: 0-4], p<0.01). In obese patients (BMI I 30), the mean placement time was 10.5 (±1.7 SD) min vs. 4.8 (±2.1 SD) min (p<0.01), and median number of needle re-directions was 2.5 [IQR: 2-3] vs. 0.5 [IQR: 0-3] (p=0.04), with the Chayen and Borghi approaches, respectively. CONCLUSION: Use of the palpable soft tissue depression at the iliac crest prominence for performing a lumbar plexus block offered several potential advantages over the standard inter-iliac crest approach.
B Borghi; A Tognù; P F White; S Paolini; H Van Oven; L Aurini; A Mordenti; S Spada; M Bosco
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-06
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Surgery and Anesthesiology Sciences, University of Bologna, Rizzoli Orthopedic Institute, Bologna, Italy -
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