Ultrasound guided obturator nerve block: a single interfascial injection technique

Abstract

We describe a new technique of single interfascial injection for 25 patients scheduled for transurethral bladder tumor resection. An ultrasound probe was placed at the midline of inguinal crease and moved medially and caudally to visualize the fascial space between the adductor longus (or pectineus) and adductor brevis muscles. We injected 20 mL 1% lidocaine containing epinephrine into the interfascial space using a transverse plane approach to make an interfascial injection, not an intramuscular swelling pattern. And just distally, firm pressure was applied for 3 min. Afterwards, surgery was performed under spinal anesthesia. The time required for identification and location of the nerve was 20 ± 15 and 30 ± 15 s, respectively. Adductor muscle strength, which was measured with a sphygmomanometer, decreased in all patients, from 122 ± 26 mmHg before blockade to 63 ± 11 mmHg 5 min after blockade. No movement or palpable muscle twitching occurred in 23 cases, slight movement of the thigh not interfering with the surgical procedure was observed in 1 case, thus the obturator reflex was successfully inhibited in 96% of cases. Ultrasound-guided single interfascial injection is an easy and successful technique for obturator nerve block.

A Cadaveric Study of Ultrasound-Guided Subpectineal Injectate Spread Around the Obturator Nerve and Its Hip Articular Branches

“…[12][13][14][15][16] To the best of our knowledge, none of the previous studies of any ultrasound-guided technique, applicable to patients with hip fracture, have investigated the proximal spread of the injectate into the obturator canal and around the obturator nerve branches innervating the hip joint capsule. Furthermore, no studies have investigated spread of injectate to the accessory obturator nerve (AON), which has been reported to innervate the hip joint capsule consistently, when present.…”

Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study

“…[22][23][24] Moreover, more recent studies reported that the use of an ultrasound in regional anesthesia is associated with higher success rates as 93% to 97.2% in ultrasound-guided ONB procedures. 21,25 Akkaya and colleagues demonstrated a new methodological approach based on a sono-anatomic study to visualize the obturator nerve. They reported patient satisfaction rates as high as 93%.…”

The Effect Of Obturator Nerve Block On Complications During Transurethral Resection Of Lateral Wall Located Bladder Tumours

“…Bir diğer yaklaşım sadece işaret noktaları kullanılarak yapılan başarı oranı daha düşük olan kör anatomik girişimdir 1 . Son dönemlerde özellikle ultrasonun bölge-sel anestezi pratiğine girmesiyle ultrason eşliğinde yapılan obturator sinir bloğunda daha az komplikasyon ile blok başarı oranının daha çok arttığını bildiren ça-lışmalar vardır (11)(12)(13).…”

“…Özellikle sıklığı %10-30 arasında gösterilen aksesuvar obturator sinir bu farkı yaratmış olabilir (12). Ultrason eşliğinde yapılan obturator sinir bloklarının başarısı ise %93 -97,2 arasında değişen oranlarda bildirilmiştir (11)(12)(13). Bu oranlar sinir uyarı-cısı kullanılan bloklara oranla ultrason eşliğinde yapı-lan blokların daha başarılı olduğunu göstermektedir.…”