A modified approach of combined anterior lumbar plexus block with lateral sacral plexus block in a semi lateral supine position for lower limb fracture patients: a case series.

Abstract

Lumbar plexus block (LPB) and sacral plexus block (SPB) are commonly used regional anesthesia techniques for lower limb surgeries. We propose a novel approach combining anterior LPB and lateral SPB in a semi-lateral supine position with a pad under the upper body. This approach minimizes discomfort and pain during position changes, enhances probe manipulation space, and aids in maintaining aseptic conditions throughout the entire operation. In a study involving 9 elderly patients undergoing hip surgery for femoral neck fractures, we used this modified anterior LPB and lateral SPB technique. Prior to the regional anesthesia, patients were sedated with dexmedetomidine, and the lumbar plexus and sacral plexus were localized using dual guidance techinques, including ultrasound and electrical nerve stimulation. This case series demonstrates the effectiveness of the modified approach, significantly minimizing pain and discomfort associated with positional changes, and is a promising modification to the classical approach. TRIAL REGISTRATION NUMBER: NCT05901415.