Case Presentation
ASA3 68yo female patient scheduled for total hip arthroplasty by trans-gluteal postero-lateral approach (left lower limb).

Our usual proposition to our patients is to combine posterior approaches to lumbar and sacral plexuses. The classical psoas compartment (catheter insertion to post-operative analgesia) and parasacral techniques can be performed under ultrasound guidance. Nevertheless, the depth of the nervous structures imposes to use a micro-curved lower frequency transducer to penetrate more easily with the ultrasounds to the plexuses. In our experience we prefer, and even recommend, combining ultrasound location with nerve stimulation to compensate the loss of quality of the ultrasound picture in the the deepness.

Author
Pierre Pandin, MD , Assistant Professor, Department of Anesthesiology and Critical Care, CUB Erasmus Hospital, Bruxelles, Belgium.

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