Ultrasound-guided lumbar plexus block using three different techniques: a comparison of ultrasound image quality

Purpose The purpose of this study was to compare the ultrasound image quality at three different transducer positions for ultrasound-guided lumbar plexus block (LPB). Methods This prospective comparative study included 30 patients who underwent total hip arthroplasty under general anesthesia in combination with LPB. Using the same ultrasound machine settings for each patient, a transverse view of the lumbar plexus (LP) at the L3-4 vertebral level was obtained with a convex transducer placed at three different positions: immediately lateral to the dorsal midline (medial position), almost 5 cm lateral to the dorsal midline (paravertebral position), and at the abdominal transverse flank (shamrock position). Ultrasound-guided LPB with catheter insertion was performed via in-plane needle insertion with the transducer randomly assigned to one of the three positions. The echo intensity (EI) ratio of the LP to psoas major muscle (PMM), the EI of the LP and PMM, and the ultrasound visibility score of the needle, local anesthetic, and catheter were recorded. Results The LP/PMM EI ratio was significantly higher at paravertebral position (1.4 +/- 0.2) than at medial position (1.2 +/- 0.2; p = 0.003) and shamrock position (1.3 +/- 0.2; p = 0.040). The EI of the LP and PMM was highest at shamrock position (p < 0.001). During the block procedure, the ultrasound visibility score of the needle and local anesthetic was significantly higher at paravertebral position than at medial position. Conclusion Under the conditions of this study, the contrast between LP and PMM is significantly higher at paravertebral position than at medial position and at the abdominal transverse flank (shamrock position). LP and PMM at the shamrock position appear significantly brighter among the three probe positions in sonograms.