From the Department of Anaesthesia, Mahidol University, Ramathibodi Hospital, Bangkok (VA, TC), Department of Anaesthesia, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand (PL, WT) and Department of Anaesthesia, Montreal General Hospital, McGill University, Montreal, Québec, Canada (RJF, DQT).
Eur J Anaesthesiol. 2018 Mar;35(3):224-230. doi: 10.1097/EJA.0000000000000736.
Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance.
We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time.
A randomised, observer-blinded, equivalence trial.
Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017.
A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia.
In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle.
We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min.
Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, -4.8; 95% confidence interval, -8.1 to -1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events.
Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min).
www.clinicaltrials in the (Study ID: TCTR20160427003).
超声引导下的腰椎丛阻滞通常需要确认神经刺激。一种更简单的替代方法是在超声引导下将局部麻醉剂注入腰大肌的后内侧象限内。
我们假设这两种技术的总麻醉时间（定义为操作时间和起效时间之和）相似。
随机、观察者设盲、等效性试验。
泰国 Ramathibodi 医院和玛哈沙拉堪清迈医院，时间为 2016 年 5 月 12 日至 2017 年 1 月 10 日。
共 110 例接受全髋关节或膝关节置换术的患者，需要腰椎丛阻滞进行术后镇痛。
在联合超声-神经刺激组中，在局部麻醉剂注射前（30ml 利多卡因 1%和左布比卡因 0.25%，含肾上腺素 5μg/ml 和 5mg 地塞米松），寻找股四头肌诱发的运动反应，电流在 0.2 至 0.8mA 之间。在仅超声引导组中，简单地将局部麻醉剂注入腰大肌的后内侧象限。
我们测量了总麻醉时间、成功率（30 分钟时）、针数、阻滞相关疼痛、累积阿片类药物消耗（24 小时时）和不良事件（血管穿刺、感觉异常、局部麻醉剂扩散至硬膜外腔）。等效性边界为 7.4 分钟。
与单独超声引导相比，联合超声-神经刺激技术可显著缩短平均（±SD）总麻醉时间[15.3（±6.5）比 20.1（±9.0）分钟；平均差值-4.8；95%置信区间-8.1 至-1.9；P=0.005]和平均（±SD）起效时间[10.2（±5.6）比 15.5（±9.0）分钟；P=0.004]。两组间成功率、操作时间、针数、阻滞相关疼痛、阿片类药物消耗或不良事件无差异。
尽管超声-神经刺激技术与单独超声引导相比，总麻醉时间更短，但这种差异在我们可接受的等效性边界内（±7.4 分钟）。
