Posterior Lumbar Plexus (Psoas Compartment) Blockade

Rebecca L. Johnson, M.D.
Resident Physician

Sandra L. Kopp, M.D.
Assistant Professor

Department of Anesthesiology
Mayo Clinic
Rochester, Minnesota

Introduction - TOP

In response to criticism that the femoral “3-in-1” block did not consistently block the femoral, obturator, and lateral femoral cutaneous nerves, Winnie et al.1  introduced the posterior approach to the lumbar plexus in 1974.  He claimed that this approach allowed blockade of both the lumbar and sacral plexuses.  Shortly after, Chayen et al.2 modified this approach and renamed it the “psoas compartment block.”  Contrary to Winnie, they reported that a sciatic block was needed in order to provide complete anesthesia of the lower extremity. Although initially described using a loss of resistance technique, Parkinson et al.3 introduced peripheral nerve stimulation in 1989. Recently, using computed tomography, Capdevila et al.4 modified Winnie’s initial landmarks to utilize a more medial insertion site at the L4 level, thus avoiding the need for medial orientation of the needle.

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