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REGIONAL ANESTHESIA

Ultrasound Guidance for the Psoas Compartment Block: An Imaging Study

Lukas Kirchmair, MD^*, Tanja Entner, MD, Stephan Kapral, MD, and Gottfried Mitterschiffthaler, MD

*Institute of Anatomy and Histology and Departments of Neurology and Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria; and Department of Anesthesiology and Intensive Care Medicine, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Lukas Kirchmair, MD, Institute of Anatomy and Histology, University of Innsbruck, Muellerstrasse 59, A-6010 Innsbruck, Austria. Address e-mail to lukas.kirchmair{at}chello.at

We conducted this study to develop an ultrasound-guided approach to the psoas compartment and to assess its feasibility and accuracy by means of computed tomography (CT). Two examiners performed ultrasound-guided approaches at three levels (L2-3, L3-4, and L4-5) on 10 embalmed cadavers, which were seated prone. After each needle had been advanced into the psoas compartment under ultrasound guidance, the positions of their tips were computed by using two coordinates (A and B). Subsequently, axial transverse CT scans were made to verify the ultrasound measurements by using the same coordinates. In total, 48 approaches were performed (Examiner 1, n = 20; Examiner 2, n = 28). CT revealed that 47 of 48 ultrasound-guided approaches were performed exactly. In 1 of 48 approaches (L3-4), the tip of the needle was located posterior to the psoas muscle. The median differences between ultrasound and CT coordinates were 0.3 ± 0.3 cm for A and 0.2 ± 0.3 for B. Kendall’s coefficient of concordance was 0.9 (P < 0.001) between ultrasound and CT measurements for both coordinates. These results indicate that ultrasound enables exact needle placement, as proved by CT. We conclude that ultrasound guidance might be a useful adjunct to increase the safety and efficacy of the psoas compartment block at these levels.

IMPLICATIONS: We developed an ultrasound-guided approach to the psoas compartment at the levels L2-3, L3-4, and L4-5. Feasibility and accuracy were tested on embalmed cadavers and verified by means of computed tomography. Ultrasound guidance proved to be feasible and accurate for the performance of psoas compartment blocks.

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