Hip Fractures, Hip Injuries
Conditions
Brief summary
The components of the lumbar plexus and capture the articular branches of hip capsule may be effectively blocked by administering a relatively high volume of local anesthetic deep to the iliacus muscle at the level of the anterior inferior iliac spine. We can provide both the blockade of the pericapsular nerve group supplying the hip capsule and the cutaneous blockade. Here, we aimed to present our novel technique we named 'deep iliacus plane block (DIPB)'.
Detailed description
Many regional anesthesia techniques are used in hip surgeries for various goals, such as optimizing neuraxial positioning and relieving pain in the perioperative period, and have been the subject of clinical researches in the last few decades. The lumbar plexus is important in administering anesthesia and analgesia during hip and knee surgeries. Comprising the femoral nerve (FN), lateral femoral cutaneous nerve (LFCN), and obturator nerve, it collaborates with the sacral plexus to ensure comprehensive innervation of the lower limb. We hypothesized that by administering a relatively high volume of local anesthetic deep to the iliacus muscle at the level of the anterior inferior iliac spine (AIIS), we could effectively block the lumbar plexus components and capture the hip capsule's articular branches. We can ensure both the blockade of the pericapsular nerve group supplying the hip capsule and the cutaneous blockade. Here, we aimed to present our cadaveric evaluation and retrospective evaluation of patients underwent meta-PENG block, which we consider the proof-of-concept for our hypothesis of the technique we named 'deep iliacus plane block (DIPB)'.
Interventions
DRUGmeta-Peng block
The convex transducer was positioned obliquely in a superolateral to inferomedial direction just above the femoral crest. Anatomical structures including AIIS, iliopubic eminence, sartorius muscle, iliopsoas muscle, psoas tendon, artery, vein, and iliac fascia were identified sono-anatomically. The AIIS was centered in the transducer image. To determine the insertion point of the rectus femoris tendon (RFT) on the AIIS, the transducer was rotated sagittally, and the level where the RFT ends cephalically was identified. After identifying the target, the transducer was obliquated again to visualize the IPE. The 22G x 100 mm block needle was advanced in-plane from lateral to inferomedial towards the potential space between the IPM and AIIS. After confirming the target plane with a few mL of saline, 30-40 mL of 0.25% bupivacain was applied to the area. The spread of injectate was observed beneath the IPM, below the psoas tendon, and around the iliacus muscle within the iliac fascia.
We ordered 400 mg intravenous ibuprofen for the patients every 8 hours during the postoperative period. We planned to perform 100 mg tramadol as a rescue analgesic if the patient's NRS score was above 4. We observed the patients for 24 hours in the postoperative period.
Sponsors
Medipol University
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Inclusion criteria
* ASA-1, ASA-2 and ASA-3 patients who underwent hip surgery under spinal or general anesthesia
Exclusion criteria
Anticoagulant drug use Known allergy to the medications to be used Infection in the area where the needle will be inserted Missing data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores (Numerical rating scale-NRS) | Before block, 30 min after block | Comparison of NRS before block, after block, and during position for surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Need for rescue analgesia (tramadol) | Postoperative 24 hours period | The secondary aim is to compare rescue analgesia used in the postoperative 24 h. |
Countries
Turkey (Türkiye)
Outcome results
None listed