Lumbar plexus block with ultrasound-guided shamrock position: in-plane versus novel out-of-plane approach Bloqueo del plexo lumbar ecoguiado con abordaje tipo Shamrock: técnica dentro del plano frente a técnica nueva fuera del plano
Revista Espanola de Anestesiologia y Reanimacion, cilt.73, sa.6, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 73 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.redar.2026.502128
- Dergi Adı: Revista Espanola de Anestesiologia y Reanimacion
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, MEDLINE, DIALNET
- Anahtar Kelimeler: Hip fractures, Lumbar plexus, Nerve block, Regional anesthesia, Ultrasonography
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: A lumbar plexus block (LPB) can be used with different techniques for anesthesia and postoperative analgesia during femoral surgery. This study aimed to compare in-plane and out-of-plane needle guidance methods using the Shamrock position. Methods: Forty-two patients scheduled for surgery due to femoral neck fractures were included in this randomized controlled study. The Shamrock position was used for lumbar plexus visualization. Patients were randomized into two groups: one group received a LPB using the in-plane technique (n = 20), and the other group received LPB using the out-of-plane technique (n = 20). The primary outcome measure was Block procedure time. Secondary outcomes included the number of needle insertions and redirections, needle depth (cm), minimal nerve stimulation (mA), sensory and motor block levels, and degree of epidural spread. Results: No statistically significant difference was found between the groups in block procedure times (p > 0.05). The number of insertions and the number of needle redirections were significantly lower in the out-of-plane group compared to the in-plane group (p = 0.005). The needle depth was significantly greater in the in-plane group compared to the out-of-plane group (6.5 ± 1.1 cm vs 5.1 ± 0.8 cm, p = 0.001). No difference was found in sensory and motor block times (p > 0.05). There was no difference in the number of patients with epidural spread or in the observed complications (p > 0.05). Conclusion: The out-of-plane technique demonstrated similar efficacy to the in-plane method in Shamrock position. The out-of-plane technique can be used as an alternative option for elderly patients who have difficulty with needle guidance.