Total spinal anesthetic after continuous posterior lumbar plexus block.

THE lumbar plexus is derived from rami from the first through the fourth lumbar nerves and is primarily responsible for innervation of the extensor and adductor compartments of the thigh. Blockade of the lumbar plexus using a posterior approach, via either a single injection or continuous technique using an indwelling catheter, is an attractive alternative for postoperative pain management in patients undergoing surgery of the hip and above the knee. This technique may enable blockade of all branches of the lumbar plexus, most notably the lateral femoral cutaneous, femoral, and obturator nerves. The genitofemoral and ilioinguinal nerves, also formed from contributions of ventral rami of the first and second lumbar nerves, are generally not considered incorporated in the block of the plexus. Also referred to as the continuous psoas compartment block, it is considered reliably safe with few complications. We report the case of a total spinal anesthetic after a posterior lumbar plexus blockade performed during general anesthesia.