Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Six. Blocks for the Lower Extremity > Chapter 33. Lumbar Plexus Block Christopher Robards, MD, Admir Hadzic, MD

Lumbar Plexus Block: Introduction

"The use of lumbar or sacral plexus blockade for lower extremity surgeries has not been commonplace until recently. This is because these techniques were thought to be difficult to perform and resulted in frequent failure to accomplish surgical anesthesia.^1–3 Dogliotti⁴ pointed out, "the nerve trunks of the lumbar plexus which run into the inferior extremity are at a great distance from each other, so much so that in order to produce anesthesia, multiple procedures are necessary with separate injections, for each nerve trunk." Hence, anesthesiologists preferred the quicker and more effective techniques of spinal or epidural anesthesia for most patients. Several variations of the original technique have been proposed, with the main differences being in the level of blockade and the distance from the midline for the needle insertion.^4–6 However, given the deep location of the lumbar plexus, various approaches often represent minuscule technical variations rather than clinically relevant modifications. For instance, Chayen's approach is thought to result in too high of an incidence of epidural blockade.⁷ However, newly proposed techniques have also resulted in a 15% incidence of epidural blockade.⁸ More recently, ultrasound-guided lumbar plexus block technique has been suggested; unfortunately this requires substantial ultrasonographic skill, and adequate images are difficult to obtain in many patients.⁹ Regardless of which technique is followed, safety precautions must be..."