and 2 other(s)
INTRODUCTION Lumbar plexus (LP) block is a successful technique for postoperative analgesia following lower extremity surgery. Several ultrasound (US) guided techniques have been described. The most promising is the Shamrock Technique , based on recognizing three muscles around the transverse process (TP) of L-4: Quadratus Lumborum (QL), Erector Spinae (ES) and Psoas Major (PM), which together form a “shamrock” sign. (Fig. 1) We used this method to perform continuous LP block for postoperative analgesia in a 50 years old man who underwent total hip replacement. METHODS The patient was placed in lateral position with the side to be blocked facing up. A low frequency curved US transducer was placed transversally in the abdominal flank and moved dorsally until the Shamrock sign was seen. The LP is a hyperechoic structure in the medial and posterior part of the PM. Tilting the probe caudally, the transverse process disappears, allowing in- plane/posteroanterior needle approach. (Fig. 2) After confirmation of the needle placement with Nerve stimulation, and a catheter-over-needle was inserted for postoperative analgesia by infusion of Ropivacaine 0.2% 5mL/h. (Fig. 3) Multimodal analgesia included ketorolac i.v. 60 mg/24h. RESULTS Postoperative analgesia resulted excellent, as the patient had a maximum pain VAS of 2. No supplemental analgesics were administered postoperative and no adverse effect occurs. The catheter was removed after 48 h and the patient was discharged on postoperative day 3. CONCLUSION The Shamrock technique has the great advantage of allowing full needle control and anatomic structures visualization, allowing an easy and successful insertion of a catheter near the LP.
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