New Page 3

Local Anesthetics

In our orthopaedic and traumatology unit, Hautepierre Hospital, Strasbourg, France we use the following protocol when performing the parasacral approach:

     •lidocaine or mepivacaine fort short procedures
     •ropivacaine for longer procedures or postoperative pain management
     •The concentrations and volumes are adjusted according to whether this block is used in
       combination with a lumbar plexus block or a saphenous block.

When the parasacral approach is used alone we use 20 mL 0.75% ropivacaine as a bolus and patient controlled administration of ropivacaine 0.2% 5mL/kg/h, bolus 5mL, with a lock-out time of 45 minutes.

When the parasacral block is combined with a lumbar plexus block
(posterior or anterior approach) we usually mix ropivacaine 0.75%
with lidocaine 2% (epinephrine 1/200000) in a 3/1 proportion. The
volumes injected for the lumbar plexus are 20 mL with the parasacral,
20 to 30 mL for the lumbar plexus depending on the weight of the patient.

When lumbar and parasacral catheters are used simultaneously, the ad-
ministration schedule is the same for both blocks. However, it is essential
that the patient understands well the location of the pain in the two terri-
tories.

Before using the catheter, we confirm the location of the catheters on a
radiograph. A typical picture resembles a spindle with a lateral-caudal
orientation and crossing the sciatic notch (figure on right).