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Ultrasound Guidance and Nerve Stimulation Combined Versus Nerve Stimulation alone for Lumbar Plexus Block: A Randomized Controlled Trial

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Summary

A nerve stimulation-guided lumbar plexus block is a well-established technique. It is not clear whether ultrasound guidance has additional value for this deep block technique. This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space (PMTS-ITS) approach in combination with nerve stimulation reduces the onset time of a complete sensory block. Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score (UVS) of ≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group (group U-N) or nerve stimulation group (group N) in this prospective, randomized, parallel-group, active-controlled study. The primary outcome was the onset time of a complete sensory block. The results showed that the onset time of a complete sensory block to pinprick and cold was 10 (10–40) min and 10 (10–40) min in group U-N, respectively, and 30 (10–40) min and 20 (10–40) min in group N (P=0.005, P=0.004), respectively. The performance time was 658±87 s in group U-N and 528±97 s in group N (P<0.001). There was no (0%) patient who required 5 or more needle passes in group U-N and 6 (27.3%) in group N (P=0.028). The block failure rate was 9.1% in group U-N and 31.8% in group N (P>0.05). In conclusion, ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS ≥10. Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

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Author notes

  1. Both authors contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Jing-yu Xiao, Yan Fang, Yao Yu, Jian Li, Ya-ru Luo, Yong Liu & Wei Mei

  2. Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, 400030, China

    Jing-yu Xiao

  3. Yantai Yuhuangding Hospital, Yantai, 264000, China

    Jian Li

  4. Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Ya-ru Luo

Authors
  1. Jing-yu Xiao
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  2. Yan Fang
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  3. Yao Yu
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  4. Jian Li
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  5. Ya-ru Luo
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  6. Yong Liu
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  7. Wei Mei
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Correspondence to Yong Liu or Wei Mei.

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The authors declare that there is no conflict of interest with any financial organization or corporation or individual that can inappropriately influence this work.

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Xiao, Jy., Fang, Y., Yu, Y. et al. Ultrasound Guidance and Nerve Stimulation Combined Versus Nerve Stimulation alone for Lumbar Plexus Block: A Randomized Controlled Trial. CURR MED SCI 40, 1182–1190 (2020). https://doi.org/10.1007/s11596-020-2307-9

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  • DOI: https://doi.org/10.1007/s11596-020-2307-9

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