Journal of Anesthesia

, Volume 32, Issue 5, pp 694–701 | Cite as

Ultrasound-guided lumbar plexus block using three different techniques: a comparison of ultrasound image quality

  • Makoto SatoEmail author
  • Tomoki Sasakawa
  • Yuki Izumi
  • Yoshiko Onodera
  • Takayuki Kunisawa
Original Article



The purpose of this study was to compare the ultrasound image quality at three different transducer positions for ultrasound-guided lumbar plexus block (LPB).


This prospective comparative study included 30 patients who underwent total hip arthroplasty under general anesthesia in combination with LPB. Using the same ultrasound machine settings for each patient, a transverse view of the lumbar plexus (LP) at the L3–4 vertebral level was obtained with a convex transducer placed at three different positions: immediately lateral to the dorsal midline (medial position), almost 5 cm lateral to the dorsal midline (paravertebral position), and at the abdominal transverse flank (shamrock position). Ultrasound-guided LPB with catheter insertion was performed via in-plane needle insertion with the transducer randomly assigned to one of the three positions. The echo intensity (EI) ratio of the LP to psoas major muscle (PMM), the EI of the LP and PMM, and the ultrasound visibility score of the needle, local anesthetic, and catheter were recorded.


The LP/PMM EI ratio was significantly higher at paravertebral position (1.4 ± 0.2) than at medial position (1.2 ± 0.2; p = 0.003) and shamrock position (1.3 ± 0.2; p = 0.040). The EI of the LP and PMM was highest at shamrock position (p < 0.001). During the block procedure, the ultrasound visibility score of the needle and local anesthetic was significantly higher at paravertebral position than at medial position.


Under the conditions of this study, the contrast between LP and PMM is significantly higher at paravertebral position than at medial position and at the abdominal transverse flank (shamrock position). LP and PMM at the shamrock position appear significantly brighter among the three probe positions in sonograms.


Local anesthetics Lumbar plexus Nerve block Ultrasound 



We thank the nursing staff and the technical staff at the Department of Device Technologies of Asahikawa Medical University Hospital.

Compliance with ethical standards

Conflict of interest

Makoto Sato has no conflict of interest; Tomoki Sasakawa has no conflict of interest; Yuki Izumi has no conflict of interest; Yoshiko Onodera has no conflict of interest; Takayuki Kunisawa has no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care MedicineAsahikawa Medical UniversityAsahikawaJapan

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