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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 35 – Lumbar Somatic Block

PERSPECTIVE

Lumbar somatic block is often used to complement an anesthetic in which multiple intercostal nerve blocks have been used. Lumbar somatic block, together with intercostal nerve block, allows anesthesia for lower abdominal and even upper leg surgery. For example, lumbar somatic block of T12, L1, and L2 covers most of the requirements for inguinal herniorrhaphy. Likewise, individual blocks of lumbar nerves (including block of T12 off the L1 spine) may allow differentiation of lower abdominal and postherniorrhaphy pain syndromes.

Patient Selection.

Lumbar somatic block is often used in a pain clinic setting. However, some surgical patients, such as those undergoing herniorrhaphy, benefit from appropriate use of the block. In addition, although the frequency of a flank incision for renal surgical procedures has decreased since the advent of lithotripsy, patients undergoing flank incisions are well managed with a combination of lower intercostal and lumbar somatic block and “light” general anesthesia.

Pharmacologic Selection.

The local anesthetic choice for lumbar somatic block is limited only by the extent of additional blockade and concerns over systemic toxicity. If pinpoint diagnostic accuracy is essential for chronic pain syndromes, local anesthetic volumes as small as 1 to 2 mL are appropriate; if surgical anesthesia is desired, volumes of 5 to 7 mL per lumbar root are appropriate.

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