A description of the spread of injectate after psoas compartment block using magnetic resonance imaging.
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Affiliation
Department of Anaesthesia and Intensive Care, Cork University Hospital &, University College, Cork, Ireland. mannionstephen@hotmail.comIssue Date
2012-02-03T15:06:13ZMeSH
AdultContrast Media/*administration & dosage
Cross-Over Studies
Gadolinium DTPA/*administration & dosage
Humans
Lumbosacral Plexus/*pathology
*Magnetic Resonance Imaging
Male
Nerve Block/*methods
Prospective Studies
Psoas Muscles/innervation/pathology
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Reg Anesth Pain Med. 2005 Nov-Dec;30(6):567-71.Journal
Regional anesthesia and pain medicineDOI
10.1016/j.rapm.2005.08.004PubMed ID
16326342Abstract
BACKGROUND AND OBJECTIVES: Magnetic resonance imaging (MRI) provides for excellent visualization of spread of solution after peripheral nerve block. The aim of this observational study was to utilize MRI to describe the distribution of injectate (gadopentetate dimeglumine) administered for continuous psoas compartment block (PCB) performed by use of two approaches (Capdevila and modified Winnie) and to describe the spread of injectate to the lumbar plexus. METHODS: Four volunteers were enrolled in a prospective crossover study. Each volunteer underwent PCB with catheter placement performed by use of Capdevila's approach followed 1 week later by PCB, with catheter placement performed by use of a modified Winnie approach. MRI of injectate distribution was performed after each PCB. RESULTS: The catheter was unable to be inserted in 1 volunteer undergoing Winnie's approach; therefore, 7 sets of MR images were analyzed. In 6 of 7 cases (4 Capdevila and 2 Winnie) spread was primarily within the psoas muscle. Contrast surrounded the L2-3 lumbar branch of the femoral nerve at L4 and cleaved the fascial plane within the psoas muscle and spread cephalad to reach the lumbar nerve roots. In 1 case (Winnie approach) contrast spread between the psoas and quadratus lumborum muscles. Contrast surrounded the femoral and obturator nerves where they lie outside the psoas muscle at L5. CONCLUSION: The most common pattern of injectate spread seen on MRI with both approaches to PCB was spread within the body of the psoas muscle around the lumbar branches (L2-4), with cephalad spread to the lumbar nerve roots. One catheter resulted in injectate between the psoas and quadratus lumborum muscles.Language
engISSN
1098-7339 (Print)1098-7339 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.rapm.2005.08.004
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