Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures

Background and Objectives. The perioperative use of continuous psoas compar tment block (CPCB) was compared with traditional pain management for patien ts with fracture of the femur. The anatomy of CPCB was also tested in cadav ers. Methods. Forty consecutive patients (range, 67-96 years old) were pros pectively randomized either to group A (given local anesthetics using a CPC B) or group B (given perioperative analgesia with meperidine). In another p art of the study, CPCB was performed in 15 fresh cadavers, and dissection o f the lumbar region was performed after dye injection. Results. Continuous psoas compartment block was performed successfully in all patients in group A and was used in the pre- (16-48 hours) and postoperative (72 hours) peri ods. Visual analog scale score in group A was lower than in group B in 5/7 preoperative and 9/9 postoperative 8 hourly assessments. Differences reache d statistical significance (P < .05) in 3 and 5 of the assessments, respect ively. Patient satisfaction was higher in group A in the pre- (P < .05) and postoperative periods (P < .03). The block failed to achieve surgical anes thesia in 85% (17/20) of the patients, and additional anesthesia was needed . The anatomic study failed to support the existence of a defined "psoas co mpartment" previously described, and supported the clinical findings. Injec ted dye was found in the region of the origin of the sciatic nerve (essenti al for the production of anesthesia for hip surgery) in only 26% (4/15) of cadavers. Conclusions. The CPCB seems to be an appropriate technique for ef ficient and safe perioperative pain control. However, in our dissections, t he psoas compartment was not well defined in all patients, thus, using this route fur anesthesia may result in only partial success.