Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging

Ali Ahiskalioglu, Serkan Tulgar, Mine Celik, Zeliha Ozer, Haci Ahmet Alici, Muhammed Enes Aydin, Ali Ahiskalioglu, Serkan Tulgar, Mine Celik, Zeliha Ozer, Haci Ahmet Alici, Muhammed Enes Aydin

Abstract

Objective: Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation.

Materials and methods: In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block.

Results: All patients' surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients' pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle.

Conclusion: Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.

Keywords: erector spinae plane block; high risk patient; hip surgery; magnetic resonance imaging.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

©Copyright 2020 by the Atatürk University School of Medicine - Available online at www.eurasianjmed.com.

Figures

Figure 1. a, b
Figure 1. a, b
a) Probe and ultrasound setup for the ESP block. b) Sonographic image of the L-ESP block. TP: transverse process
Figure 2. a–e
Figure 2. a–e
Magnetic resonance imaging scan (T1-weighted with fat saturation) with gadolinium contrast injected at the level of L4. a) Sagittal view and epidural spread. Axial views b) L3, c) L2, d) L4, and e) L5 b). PM: psoas major; QLM: quadratus lumborum muscle Yellow arrow: interforaminal spread; red arrow: lumbar plexus spread; blue arrow: paravertebral spread; green arrows: epidural spread

Source: PubMed

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