Lumbar Plexus Blocks (Psoas Compartment Blocks) (con't)

When long lasting pain relief is sought, a catheter can be inserted within the psoas compartment, using an appropriate device [43,44] and a 5 mL/h continuous infusion of 0.125% bupivacaine or 0.2% ropivacaine in children weighing more than 30 Kg usually provides excellent analgesia (this dose can be adjusted by titration later on). It should be noted that the blockade can occasionally involve spread to the epidural or subarachnoid space, a complications once more frequent before the advent of insulated block needles [42]. Nevertheless, this potential side effect has to be consi-dered when selecting this technique and the injected volume of local anesthetic should not exceed 20 mL (Table 2). Finally, due to the possible complications arising from intraperitoneal insertion of the needle, the indications of direct lumbar plexus blocks should be reserved to unilateral major surgery involving the hip, femur bone and thigh, and the knee.









Table 2. Commonly used volumes of local anesthetic for usual lower extremity nerve blocks (single shot procedures)