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Correspondence |
Surrey, UK
To the Editor:
Souron et al. point out that the innervation to the hip joint arises from the lumbar as well as the sacral plexus and that analgesia will be incomplete with a psoas compartment block alone.1 The lateral cutaneous nerve of the thigh (LCNT) can still be missed in about 5% of cases.2 Cross innervation from the gluteal nerves into the LCNT territory and the relatively low volume of local anesthetic used in this study may equally have contributed to a reduced success rate. A single shot psoas block is also known to have a shorter duration of action compared with intrathecal morphine. A central neuraxial technique will always be more reliable.
In our view the authors are comparing apples with oranges.
We use a continuous psoas compartment block, combined with a single shot parasacral block, as described by Mansour.3 The psoas block is initiated with 40 mL of prilocaine 1% and 10 mL of bupivacaine 0.5%. For the parasacral block we use 20 mL of bupivacaine 0.5%. In conjunction with general anesthesia no further analgesia is required intraoperatively. A further bolus of 20 mL of bupivacaine 0.25% is required after about six hours. Postoperative analgesia is provided with a continuous infusion of bupivacaine 0.125% at 10 mL•hr-1 until 12 hr before mobilization.
Using this technique our patients often complain about pain in the back and other joints unrelated to their surgery. Souron et al. do not refer to the site of pain in their patients, making pain scores on their own unreliable in comparing the effectiveness of these two techniques.
References
1 Souron V, Delaunay L, Schifrine P. Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty. Can J Anesth 2003; 50: 574–9.
2 Tokat O, Turker YG, Uckunkaya N, Yilmazlar A. A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block. J Int Med Res 2002; 30: 161–7.[Medline]
3 Mansour NY. Reevaluating the sciatic nerve block: another landmark for consideration. Reg Anesth 1993; 18: 322–3.[Medline]
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