Analgesic efficacy of an ultrasound-guided single puncture, dual injection, anterior approach targeting branches of the lumbosacral plexus versus lumbar epidural for unilateral lower limb orthopedic surgery: A randomized controlled study

Abstract Background and Aims: The traditional approach to combined lumbar and sacral plexus block require multiple injections with the patient in the lateral or prone position. We designed a study to compare the novel single puncture, dual injection, anterior approach targeting the branches of the lumbosacral plexus versus lumbar epidural for postoperative analgesia. Material and Methods: The present study enrolled 134 adult patients scheduled for unilateral lower limb orthopedic surgery under combined spinal epidural anesthesia without epidural activation. Study participants were randomly assigned to either group B (lumbosacral plexus block) or group E (lumbar epidural). Postoperatively, patients in group ‘B’ received the ultrasound-guided single puncture, dual injection, block via anterior approach targeting the branches of the ipsilateral lumbosacral plexus, while patients in group ‘E’ received lumbar epidural. All patients received patient-controlled epidural analgesia (PCEA). The primary objective of the study was to compare postoperative analgesia as assessed by numerical rating scale (NRS) score at predefined time points (0, 1, 3, 6, 12, 18, and 24 h) between groups. The secondary objectives were the comparison of sensory block, motor block, rescue analgesic requirement, complications, and patient satisfaction. Results: Patients in group B had significantly lower median (quartile) NRS scores (at rest and movement) at predefined time points compared to patients in group E ( P -value < 0.001). The median PCEA pump boluses attempted and delivered were significantly lower in group B ( P -value < 0.001), and a lesser number of patients required rescue analgesia in group B than in group E ( P -value < 0.001). Group B had fewer patients with hypotension and PONV and a significantly higher median satisfaction score than group E ( P < 0.001). Conclusions: The ultrasound-guided single puncture, dual injection, anterior approach targeting branches of the lumbosacral plexus provides better postoperative analgesia and is as safe as epidural analgesia.