Abstract

Background: A posterior lumbar plexus block or psoas compartment block is an effective locoregional anesthetic technique for anesthesia and analgesia. The aim of this study was to evaluate the efficacy of a single injection of 40ml of 0.25% levobupivacaine (S75:R25) through neurostimulator-assisted psoas compartment block for postoperative analgesia in elderly patients undergoing femur surgery in lateral recumbency.
Methods: One hundred and sixty elderly patients with a femur fracture received a lumbar plexus block in the psoas compartment at the end of the surgery, still under the effect of spinal anesthesia, and pain was evaluated six hours after the injection and 24 hours after the blockade. The need for rescue with opioids and the complications of the block were evaluated.
Results: Evaluation of the five nerves showed that they were all blocked in all patients at the six-hour post-injection evaluation. In the evaluation performed 24 hours later, only 40 patients (25%) had all five nerves blocked. The mean time to perform the block and local anesthetic injection was 3:00±0:36 minutes. The mean duration of analgesia was 24:16±3:98 hours, with a minimum value of 16 hours and a maximum of 34 hours. The lock has reduced the amount of postoperative opioids and only three patients required additional analgesic. No complications were reported in any patients.
Conclusion: Posterior lumbar plexus block (psoas compartment) has been shown to be effective for both anesthesia and analgesia after femoral fracture surgery. The lumbar plexus block decreases opioid consumption, enhances patient comfort, and promotes postoperative ambulation and physical therapy. It can play a pivotal role in enhanced recovery programs for hip surgery, applied to elderly patients with femoral fractures in a hospital of the Brazilian Health System (SUS).

Keywords: Electric nerve stimulation; Psoas compartment block; Levopubivacaine; Complications; Femur fracture