노인에서 고관절 성형술을 위한 요근구역 차단법

Abstract

Psoas compartment block for hip arthroplasty was evaluated clinically in 32, either sex, geriatric patients. To perform the block, the patient was placed in a lateral decubitus position and a line was drawn, connecting both iliac crests (intercristal line). 22G teflon-coated needle of 10cm-length was inserted at a point 3cm caudad to the intercristal line and 5cm lateral to the spinal midline on the side to be blocked. The nerve stimulator (1-3mA, 1Hz), Pajunk (GMBH, Geisingen, West-Germany), was used to elicit paresthesia or muscle twitching on the patient's ipsilateral leg. The block was performed with administration of a mixture of 15 ml of 1.5 % lidocaine, 15 ml of 0.5 % bupivacaine and 0.15 mg of epinephrine. The onset time of the block was 4.4+/-1.6 minutes and its duration was 3.8+/-1.5 hours. The mean value of the lowest mean arterial pressure during the first 1 hour after the injection of local anesthetics, 85.7+/-9.8 mmHg was lower, compared to the preanesthetic baseline value, 98.2+/-16.5 mmHg. The failure rate was 9.4% and any significant systemic toxicity was not seen. There were some intraoperative complaints such as the discomfort due to position bars. However, there was no remarkable problem intraoperatively. The results indicate that psoas compartment block is a recommendable safe anesthetic technique for hip arthroplasty in geriatric patients.