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Thomas Fichtner Bendtsen - One of the best experts on this subject based on the ideXlab platform.
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Superiority of ultrasound-guided Shamrock Lumbar Plexus block.
Minerva anestesiologica, 2017Co-Authors: Martin Vedel Nielsen, Thomas Fichtner Bendtsen, Jens BorglumAbstract:Ultrasound-guided Lumbar Plexus block (LPB) performed with the Shamrock approach has received much interest since the technique was first described in 2013. The technique is believed to be faster and easier to perform and possibly safer in regards to potential complications compared with other LPBs. In order to outline some favorable characteristics of the Shamrock LPB, we performed an exhaustive search of the current literature; even though it is rather limited. We have related the evidence to our own clinical experience about the block execution. We present a narrative review of the alleged superiority of the ultrasound-guided Shamrock LPB. Our aim was to assess some of the characteristics that we believe differentiate the Shamrock technique from other ultrasound-guided LPB techniques. We present graphical directions about how to carry out the Shamrock block, and we present novel magnetic resonance images illustrating the injectate spread around the Lumbar Plexus within the intrapsoas compartment after Shamrock guided injection of contrast enhanced local anesthetic. The Shamrock approach is easier, faster and better to visualise the LPB compared to other LPB techniques. The needle trajectory and needle tip location just lateral to the Lumbar Plexus probably reduces the risk of adverse effects and complications. Ultrasound guided Lumbar Plexus blockade is an expert technique. The Shamrock technique improves but does not eliminate all the challenges of ultrasound-guided LPB technique.
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Ultrasound-guided Lumbar Plexus block in volunteers; a randomized controlled trial.
British journal of anaesthesia, 2017Co-Authors: Jennie Maria Christin Strid, Kyrre Ullensvang, Erik Morre Pedersen, Jens Borglum, Kjeld Søballe, A.r. Sauter, Morten Andersen, Morten Daugaard, Mathias Alrø Fichtner Bendtsen, Thomas Fichtner BendtsenAbstract:Abstract Background The currently best-established ultrasound-guided Lumbar Plexus block (LPB) techniques use a paravertebral location of the probe, such as the Lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the Lumbar Plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the Lumbar Plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock vs LUT. Methods Twenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine–adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics. Results The shamrock LPB procedure was faster than LUT (238 [sd 74] vs 334 [156] s; P=0.009), more comfortable {numeric rating scale 0–10: 3 [interquartile range (IQR) 2–4] vs 4 [3–6]; P=0.03}, and required fewer needle insertions (2 [IQR 1–3] vs 6 [2–12]; P=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (P=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups. Conclusions Shamrock was faster, more comfortable, and equally effective compared with LUT. Clinical trial registration NCT02255591.
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the shamrock Lumbar Plexus block a dose finding study
European Journal of Anaesthesiology, 2015Co-Authors: Axel R. Sauter, Havard T Lorentzen, Geir Niemi, Kyrre Ullensvang, Are Hugo Pripp, Thomas Fichtner Bendtsen, Jens Borglum, Luis RomundstadAbstract:BACKGROUND The Shamrock technique is a new method for ultrasound-guided Lumbar Plexus blockade. Data on the optimal local anaesthetic dose are not available. OBJECTIVE The objective of this study is to estimate the effective dose of ropivacaine 0.5% for a Shamrock Lumbar Plexus block. DESIGN A prospective dose-finding study using Dixon's up-and-down sequential method. SETTING University Hospital Orthopaedic Anaesthesia Unit. INTERVENTION Shamrock Lumbar Plexus block performance and block assessment were scheduled preoperatively. Ropivacaine 0.5% was titrated with the Dixon and Massey up-and-down method using a stepwise change of 5 ml in each consecutive patient. Combined blocks of the femoral, the lateral femoral cutaneous and the obturator nerve were prerequisite for a successful Lumbar Plexus block. PATIENTS Thirty patients scheduled for lower limb orthopaedic surgery completed the study. MAIN OUTCOME MEASURES The minimum effective anaesthetic volume of ropivacaine 0.5% (ED50) to achieve a successful Shamrock Lumbar Plexus block in 50% of the patients. Further analysis of the data was performed with a logistic regression model to calculate ED95 and to estimate the effective doses for a sensory Lumbar Plexus block not requiring a motor block of the femoral nerve. RESULTS The Dixon and Massay estimate of the ED50 was 20.4 [95% confidence interval (95% CI) 13.9 to 30.0] ml ropivacaine 0.5%. The logistic regression estimate of the ED95 was 36.0 (95% CI 19.7 to 52.2) ml ropivacaine 0.5%. For a sensory Lumbar Plexus block, the ED50 was 17.1 (95% CI 12.3 to 21.9) ml and the ED95 was 25.8 (95% CI 18.6 to 33.1) ml. CONCLUSION A volume of 20.4 ml ropivacaine 0.5% provided a successful Shamrock Lumbar Plexus block in 50% of the patients. A volume of 36.0 ml would be successful in 95% of the patients. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01956617.
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the suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p < 0.05). Both techniques are effective for blockade of the terminal nerves of the Lumbar Plexus. The suprasacral parallel shift technique is 50% effective for blockade of the lumbosacral trunk.
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The suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers – a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p
Jens Borglum - One of the best experts on this subject based on the ideXlab platform.
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Superiority of ultrasound-guided Shamrock Lumbar Plexus block.
Minerva anestesiologica, 2017Co-Authors: Martin Vedel Nielsen, Thomas Fichtner Bendtsen, Jens BorglumAbstract:Ultrasound-guided Lumbar Plexus block (LPB) performed with the Shamrock approach has received much interest since the technique was first described in 2013. The technique is believed to be faster and easier to perform and possibly safer in regards to potential complications compared with other LPBs. In order to outline some favorable characteristics of the Shamrock LPB, we performed an exhaustive search of the current literature; even though it is rather limited. We have related the evidence to our own clinical experience about the block execution. We present a narrative review of the alleged superiority of the ultrasound-guided Shamrock LPB. Our aim was to assess some of the characteristics that we believe differentiate the Shamrock technique from other ultrasound-guided LPB techniques. We present graphical directions about how to carry out the Shamrock block, and we present novel magnetic resonance images illustrating the injectate spread around the Lumbar Plexus within the intrapsoas compartment after Shamrock guided injection of contrast enhanced local anesthetic. The Shamrock approach is easier, faster and better to visualise the LPB compared to other LPB techniques. The needle trajectory and needle tip location just lateral to the Lumbar Plexus probably reduces the risk of adverse effects and complications. Ultrasound guided Lumbar Plexus blockade is an expert technique. The Shamrock technique improves but does not eliminate all the challenges of ultrasound-guided LPB technique.
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Ultrasound-guided Lumbar Plexus block in volunteers; a randomized controlled trial.
British journal of anaesthesia, 2017Co-Authors: Jennie Maria Christin Strid, Kyrre Ullensvang, Erik Morre Pedersen, Jens Borglum, Kjeld Søballe, A.r. Sauter, Morten Andersen, Morten Daugaard, Mathias Alrø Fichtner Bendtsen, Thomas Fichtner BendtsenAbstract:Abstract Background The currently best-established ultrasound-guided Lumbar Plexus block (LPB) techniques use a paravertebral location of the probe, such as the Lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the Lumbar Plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the Lumbar Plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock vs LUT. Methods Twenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine–adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics. Results The shamrock LPB procedure was faster than LUT (238 [sd 74] vs 334 [156] s; P=0.009), more comfortable {numeric rating scale 0–10: 3 [interquartile range (IQR) 2–4] vs 4 [3–6]; P=0.03}, and required fewer needle insertions (2 [IQR 1–3] vs 6 [2–12]; P=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (P=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups. Conclusions Shamrock was faster, more comfortable, and equally effective compared with LUT. Clinical trial registration NCT02255591.
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the shamrock Lumbar Plexus block a dose finding study
European Journal of Anaesthesiology, 2015Co-Authors: Axel R. Sauter, Havard T Lorentzen, Geir Niemi, Kyrre Ullensvang, Are Hugo Pripp, Thomas Fichtner Bendtsen, Jens Borglum, Luis RomundstadAbstract:BACKGROUND The Shamrock technique is a new method for ultrasound-guided Lumbar Plexus blockade. Data on the optimal local anaesthetic dose are not available. OBJECTIVE The objective of this study is to estimate the effective dose of ropivacaine 0.5% for a Shamrock Lumbar Plexus block. DESIGN A prospective dose-finding study using Dixon's up-and-down sequential method. SETTING University Hospital Orthopaedic Anaesthesia Unit. INTERVENTION Shamrock Lumbar Plexus block performance and block assessment were scheduled preoperatively. Ropivacaine 0.5% was titrated with the Dixon and Massey up-and-down method using a stepwise change of 5 ml in each consecutive patient. Combined blocks of the femoral, the lateral femoral cutaneous and the obturator nerve were prerequisite for a successful Lumbar Plexus block. PATIENTS Thirty patients scheduled for lower limb orthopaedic surgery completed the study. MAIN OUTCOME MEASURES The minimum effective anaesthetic volume of ropivacaine 0.5% (ED50) to achieve a successful Shamrock Lumbar Plexus block in 50% of the patients. Further analysis of the data was performed with a logistic regression model to calculate ED95 and to estimate the effective doses for a sensory Lumbar Plexus block not requiring a motor block of the femoral nerve. RESULTS The Dixon and Massay estimate of the ED50 was 20.4 [95% confidence interval (95% CI) 13.9 to 30.0] ml ropivacaine 0.5%. The logistic regression estimate of the ED95 was 36.0 (95% CI 19.7 to 52.2) ml ropivacaine 0.5%. For a sensory Lumbar Plexus block, the ED50 was 17.1 (95% CI 12.3 to 21.9) ml and the ED95 was 25.8 (95% CI 18.6 to 33.1) ml. CONCLUSION A volume of 20.4 ml ropivacaine 0.5% provided a successful Shamrock Lumbar Plexus block in 50% of the patients. A volume of 36.0 ml would be successful in 95% of the patients. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01956617.
Bernhard Moriggl - One of the best experts on this subject based on the ideXlab platform.
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the suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p < 0.05). Both techniques are effective for blockade of the terminal nerves of the Lumbar Plexus. The suprasacral parallel shift technique is 50% effective for blockade of the lumbosacral trunk.
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The suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers – a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p
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Lumbar Plexus and Psoas Major Muscle: Not Always as Expected
Regional anesthesia and pain medicine, 2008Co-Authors: L. Kirchmair, Philipp Lirk, Joshua Colvin, Gottfried Mitterschiffthaler, Bernhard MorigglAbstract:Background and Objectives Conflicting definitions concerning the exact location of the Lumbar Plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the Lumbar Plexus and the psoas major muscle as well as Lumbar Plexus anatomy at the L4-L5 level. Methods Sixty-three Lumbar Plexuses from 32 embalmed cadavers were dissected to determine the topographical relation between Lumbar Plexus and psoas major muscle. At the L4-L5 levels variability in the course of the femoral as well as obturator nerve were described. Results The Lumbar Plexus was situated within the psoas major muscle in 61 of 63 cases. In 2 of 63 cases the entire Plexus was localized posterior to the psoas major muscle. In the 61 of 63 cases in which the Lumbar Plexus was situated within the psoas major muscle, emergence of the individual nerves most often occurred on the posterior or posterolateral surface. Conclusions Our results synthesize contrasting assumptions in previous literature, by demonstrating that both locations of the Lumbar Plexus may be encountered in clinical practice: within and posterior to the psoas major muscle. However, the latter situation represents a minor variant. At the level of L4-L5 the femoral nerve, showing a remarkable degree of branching, as well as the obturator nerve, were found within the psoas major muscle in the vast majority of specimens.
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a study of the paravertebral anatomy for ultrasound guided posterior Lumbar Plexus block
Anesthesia & Analgesia, 2001Co-Authors: Lukas Kirchmair, Bernhard Moriggl, Tanja Entner, Jorg Wissel, S Kapral, Gottfried MitterschiffthalerAbstract:IMPLICATIONS: We investigated the feasibility of posterior paravertebral sonography as a basis for ultrasound-guided posterior Lumbar Plexus blockades. Posterior paravertebral sonography proved to be a reliable as well as accurate imaging procedure for visualization of the Lumbar paravertebral region except the Lumbar Plexus.
B. Iversen - One of the best experts on this subject based on the ideXlab platform.
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the suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p < 0.05). Both techniques are effective for blockade of the terminal nerves of the Lumbar Plexus. The suprasacral parallel shift technique is 50% effective for blockade of the lumbosacral trunk.
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The suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers – a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p
Jennie Maria Christin Strid - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound-guided Lumbar Plexus block in volunteers; a randomized controlled trial.
British journal of anaesthesia, 2017Co-Authors: Jennie Maria Christin Strid, Kyrre Ullensvang, Erik Morre Pedersen, Jens Borglum, Kjeld Søballe, A.r. Sauter, Morten Andersen, Morten Daugaard, Mathias Alrø Fichtner Bendtsen, Thomas Fichtner BendtsenAbstract:Abstract Background The currently best-established ultrasound-guided Lumbar Plexus block (LPB) techniques use a paravertebral location of the probe, such as the Lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the Lumbar Plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the Lumbar Plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock vs LUT. Methods Twenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine–adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics. Results The shamrock LPB procedure was faster than LUT (238 [sd 74] vs 334 [156] s; P=0.009), more comfortable {numeric rating scale 0–10: 3 [interquartile range (IQR) 2–4] vs 4 [3–6]; P=0.03}, and required fewer needle insertions (2 [IQR 1–3] vs 6 [2–12]; P=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (P=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups. Conclusions Shamrock was faster, more comfortable, and equally effective compared with LUT. Clinical trial registration NCT02255591.
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the suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p < 0.05). Both techniques are effective for blockade of the terminal nerves of the Lumbar Plexus. The suprasacral parallel shift technique is 50% effective for blockade of the lumbosacral trunk.
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The suprasacral parallel shift vs Lumbar Plexus blockade with ultrasound guidance in healthy volunteers – a randomised controlled trial
Anaesthesia, 2014Co-Authors: Thomas Fichtner Bendtsen, Jørgen B. Hasselstrøm, Simon Haroutounian, Lone Nikolajsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Anne K. Fisker, Bernhard Moriggl, Kjeld Søballe, B. IversenAbstract:Summary Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral Plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the Lumbar Plexus and the lumbosacral trunk with ultrasound-guided blockade of the Lumbar Plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal Lumbar Plexus nerves compared with a Lumbar Plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a Lumbar Plexus block. The primary outcome was sensory dermatome anaesthesia of L2–S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2–S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2–S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five Lumbar Plexus blocks). Success rates of the sensory and motor blockade were 88–100% for the major Lumbar Plexus nerves with the suprasacral technique, and 59–88% with the Lumbar Plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the Lumbar Plexus block (p
