Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 788-510, Japan.
J Anesth. 2018 Oct;32(5):694-701. doi: 10.1007/s00540-018-2539-z. Epub 2018 Jul 30.
The purpose of this study was to compare the ultrasound image quality at three different transducer positions for ultrasound-guided lumbar plexus block (LPB).
This prospective comparative study included 30 patients who underwent total hip arthroplasty under general anesthesia in combination with LPB. Using the same ultrasound machine settings for each patient, a transverse view of the lumbar plexus (LP) at the L3-4 vertebral level was obtained with a convex transducer placed at three different positions: immediately lateral to the dorsal midline (medial position), almost 5 cm lateral to the dorsal midline (paravertebral position), and at the abdominal transverse flank (shamrock position). Ultrasound-guided LPB with catheter insertion was performed via in-plane needle insertion with the transducer randomly assigned to one of the three positions. The echo intensity (EI) ratio of the LP to psoas major muscle (PMM), the EI of the LP and PMM, and the ultrasound visibility score of the needle, local anesthetic, and catheter were recorded.
The LP/PMM EI ratio was significantly higher at paravertebral position (1.4 ± 0.2) than at medial position (1.2 ± 0.2; p = 0.003) and shamrock position (1.3 ± 0.2; p = 0.040). The EI of the LP and PMM was highest at shamrock position (p < 0.001). During the block procedure, the ultrasound visibility score of the needle and local anesthetic was significantly higher at paravertebral position than at medial position.
Under the conditions of this study, the contrast between LP and PMM is significantly higher at paravertebral position than at medial position and at the abdominal transverse flank (shamrock position). LP and PMM at the shamrock position appear significantly brighter among the three probe positions in sonograms.
本研究旨在比较三种不同探头位置下超声引导下腰丛阻滞（LPB）的超声图像质量。
本前瞻性对照研究纳入了 30 例在全身麻醉下接受全髋关节置换术并联合 LPB 的患者。对于每位患者，使用相同的超声机设置，在 L3-4 椎体水平获得腰椎丛（LP）的横切面，使用凸阵探头置于三个不同位置：靠近背中线的外侧（内侧位置）、几乎距背中线 5 厘米的外侧（椎旁位置）和腹部横侧（三叶位置）。通过平面内针插入进行超声引导下 LPB 和导管插入，探头随机分配到三个位置之一。记录 LP 与腰大肌（PMM）的回声强度（EI）比值、LP 和 PMM 的 EI 以及针、局部麻醉剂和导管的超声可视性评分。
椎旁位置的 LP/PMM EI 比值（1.4±0.2）显著高于内侧位置（1.2±0.2；p=0.003）和三叶位置（1.3±0.2；p=0.040）。三叶位置的 LP 和 PMM 的 EI 最高（p<0.001）。在阻滞过程中，椎旁位置的针和局部麻醉剂的超声可视性评分显著高于内侧位置。
在本研究条件下，LP 与 PMM 之间的对比度在椎旁位置显著高于内侧位置和腹部横侧（三叶位置）。在三种探头位置中，LP 和 PMM 在三叶位置的超声图像中显得更亮。
