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    Introduction Anatomy
Review Indications Contra-
indications Equipment Reference
Points Block Performance Protocols Complications Control By Dr. Philippe Macaire
Lyon, France Equipment

We prefer using needles with external markings
(cm) to falicilate the estimation of the depth.
For the single-shot technique, we use the insu-
lated 22 G or 24 G nerve stimulator needles of
100 mm or 120 mm length with either cutting or
pencil-point types.
For the catheter technique, we use a set with
100 mm or 120 mm long needles which are de-
signed to allow introduction of the catheter
through the needle. Again, needles with external
markings are desirable.

Cutaneous reference points

We recommend to trace the following reference marks with a pencil (Figure 1):
     •The horizontal line linking the node of the ilia-ques peaks which locates the level L4
     •L5 L3, L4, L5 spinous processes

     The point of puncture is 40 mm lateral to the spinous process of L4 (Figure 1). Please
     note that point differs from those traditionally suggested for the following reasons:
     Figure 1.
     1. The vertical line passing through the iliaque crest is too external; this is confirmed by
         the anatomical study or radiologique (anatomical cuts in L4 and scanner in L5).
     2. The transverse process is reliably contacted when the needle is introduced at the L4
         level. Its contact is an excellent reference mark.

Lumbar Plexus Block
(Posterior Approach)