BJA Advance Access originally published online on October 22, 2008
British Journal of Anaesthesia 2008 101(6):750-760; doi:10.1093/bja/aen298
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Psoas compartment block for lower extremity surgery: a meta-analysis
1 Department of Anaesthesia and Pain Medicine, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
2 Department of Anaesthesia and Intensive Care, Zaans Medical Centre, PO Box 210, 1500 EE Zaandam, The Netherlands
3 Institute for Research in Extramural Medicine (EMGO), PO Box 7057, 1007 MB Amsterdam, The Netherlands
* Corresponding author. E-mail: ma.deleeuw{at}planet.nl
Psoas compartment block (PCB) is a potentially useful but controversial technique for lower limb surgery. We have conducted a systematic review of the efficacy and safety of PCB for anaesthesia and postoperative analgesia for hip and knee surgery. Relevant studies were identified within PubMed, EMBASE, and the Cochrane Library. The main outcome measure for anaesthesia was anaesthetic efficacy. For postoperative analgesia, the severity of postoperative pain was compared. The data were subjected to meta-analysis using relative risks with 95% confidence intervals (95% CI) for dichotomous variables and weighted mean differences with 95% CI for continuous variables. Thirty publications were included. PCB is an effective intervention for analgesia after hip and knee surgery. It appears superior to opioids for pain relief after hip surgery. This analgesic benefit may be extended beyond 8 h by the use of a catheter technique. Compared with Winnie’s 3-in-1 block, PCB is associated with more consistent block of the obturator nerve. PCB may be an alternative to postoperative neuraxial block. Although PCB combined with sciatic nerve block and sedation is an effective technique for minor knee surgery, there is currently insufficient data to recommend the use of this approach for hip and major knee surgery. PCB is a safe and effective alternative for analgesia after hip and knee surgery. More research is required to define its role in the intraoperative setting and confirm potentially beneficial effects on variables such as perioperative haemodynamics and blood loss.
Keywords: anaesthetic techniques, regional, lumbar plexus; anaesthetic techniques, regional, psoas compartment block; analgesia, postoperative; analgesics opioid; surgery, orthopaedic
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