LKnative – Lumbosacral plexus block

Indications

The single-injection suprasacral parallel shift (SSPS) lumbosacral plexus block is indicated for:

– preoperative analgesia before hip fracture surgery as an alternative to femoral nerve block

– postoperative analgesia after major hip or proximal thigh surgery

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Anatomy of the relationship between the lumbar plexus and the psoas major

The lumbar plexus and its terminal branches are contained partly inside the fascial space between the large anterior and the thin posterior lamina of the psoas major. In the lumbar paravertebral region, the two layers make a sort of a pocket towards the neural foramina of the vertebral column.

Below the transverse process (TP) of vertebral body L5 the psoas major deviates antero-laterally and creates a space – the socalled “psoas compartment” between the ala sacra and the psoas major. The terminal nerves of the lumbar plexus exit the psoas major at the level of the TP L5 and descend inside the psoas compartment together with the lumbosacral trunk (L4-L5) that is the most cranial component of the sacral plexus and supply the major part of the sacral innervation to the hip joint.