PMID- 22772854
OWN - NLM
STAT- MEDLINE
DCOM- 20131119
LR  - 20220310
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 78
IP  - 12
DP  - 2012 Dec
TI  - Soft tissue depression at the iliac crest prominence: a new landmark for 
      identifying the L4-L5 interspace.
PG  - 1348-56
AB  - BACKGROUND: One of the most common approaches to identifying the L4-L5 interspace 
      is using the iliac crest as a landmark. We propose a new landmark to identify the 
      L4-L5 interspace based on the soft tissue depression palpable at the iliac crest 
      prominence. The aim of this study was to assess the reliability and time saving 
      when using this new landmark compared to using the iliac crest to perform a 
      lumbar plexus block. METHODS: Fifty-four patients scheduled for lower limb 
      surgery were randomly allocated to have a lumbar plexus block performed using the 
      iliac crest (Chayen's approach) or the soft tissue depression (Borghi's 
      approach). The landmarks for both approaches were drawn on each patient prior to 
      randomization (N.=27 per group). All the blocks were performed by an 
      anesthesiologist familiar with both techniques using a nerve stimulator and 30 mL 
      of 0.5% levobupivacaine. The time to achieve successful needle placement and the 
      number of needle re-directions, as well as the onset time for the sensory and 
      motor blockade, were recorded. RESULTS: All the blocks using Borghi's approach 
      were performed successfully. With the Chayen's approach, there were 5 needle 
      placement failures. The mean times to onset of a successful block after injection 
      of the local anesthetic did not differ between the two groups: 17.8+/-3.9 min for 
      the Chayen vs. 15.9+/-2.4 min for the Borghi's approach (P=0.14). However, the mean 
      time to achieve correct needle placement was 7.6+/-3.2 min with the Chayen's 
      approach compared to 5.1 (+/-2.6 SD) min with the Borghi's approach (P<0.01). The 
      Chayen's approach also required a significantly higher median number of needle 
      redirections (2 [inter-quartile range (IQR): 0-4] vs. 0 [IQR: 0-4], P<0.01). In 
      obese patients (BMI >/=30 kg/m(2)), the mean placement time was 10.5+/-1.7 min vs. 
      4.8+/-2.1 min (P<0.01), and median number of needle re-directions was 2.5 (IQR: 
      2-3) vs. 0.5 (IQR: 0-3) (P=0.04), with the Chayen and Borghi's approach, 
      respectively. CONCLUSION: Use of the palpable soft tissue depression at the iliac 
      crest prominence for performing a lumbar plexus block offered several potential 
      advantages over the standard inter-iliac crest approach.
FAU - Borghi, B
AU  - Borghi B
AD  - Department of Surgery and Anesthesiology, University of Bologna, Research Unit of 
      Anesthesia and Intensive Care, Rizzoli Orthopedic Institute, Bologna, Italy.
FAU - Tognu, A
AU  - Tognu A
FAU - White, P F
AU  - White PF
FAU - Paolini, S
AU  - Paolini S
FAU - Van Oven, H
AU  - Van Oven H
FAU - Aurini, L
AU  - Aurini L
FAU - Mordenti, A
AU  - Mordenti A
FAU - Spada, S
AU  - Spada S
FAU - Bosco, M
AU  - Bosco M
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20120706
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
SB  - IM
CIN - Minerva Anestesiol. 2012 Dec;78(12):1316-8. PMID: 23222998
MH  - Aged
MH  - Anatomic Landmarks/*anatomy & histology
MH  - Anesthesia, Spinal/methods
MH  - Female
MH  - Humans
MH  - Ilium/*anatomy & histology
MH  - Lumbar Vertebrae/*anatomy & histology
MH  - Male
MH  - Middle Aged
MH  - Reproducibility of Results
EDAT- 2012/07/10 06:00
MHDA- 2013/11/20 06:00
CRDT- 2012/07/10 06:00
PHST- 2012/07/10 06:00 [entrez]
PHST- 2012/07/10 06:00 [pubmed]
PHST- 2013/11/20 06:00 [medline]
AID - R02127773 [pii]
PST - ppublish
SO  - Minerva Anestesiol. 2012 Dec;78(12):1348-56. Epub 2012 Jul 6.