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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Helayel PE, da Conceicao DB, Pavei P, Knaesel JA, de Oliveira Filho GR. Ultrasound-guided obturator nerve block: a preliminary report of a case series. Reg Anesth Pain Med. 2007;32:221–6.
Akkaya T, Ozturk E, Comert A, Ates Y, Gumus H, Ozturk H, Tekdemir I, Elhan A. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth Analg. 2009;108:1037–41.
Anagnostopoulou S, Kostopanagiotou G, Paraskeuopoulos T, Chantzi C, Lolis E, Saranteas T. Anatomic variations of the obturator nerve in the inguinal region: implications in conventional and ultrasound regional anesthesia techniques. Reg Anesth Pain Med. 2009;34:33–9.
Sinha SK, Abrams JH, Houle TT, Weller RS. Ultrasound-guided obturator nerve block: an interfascial injection approach without nerve stimulation. Reg Anesth Pain Med. 2009;34:261–4.
Saranteas T, Paraskeuopoulos T, Alevizou A, Kouskouri A, Zogojiannis J, Anagnostopoulou S, Chantzi C. Identification of the obturator nerve divisions and subdivisions in the inguinal region: a study with ultrasound. Acta Anaesthesiol Scand. 2007;51:1404–6.
Lang SA, Yip RW, Chang PC, Gerard MA. The femoral 3-in-1 block revisited. J Clin Anesth. 1993;5:292–6.
Enneking FK, Chan V, Greger J, Hadzic A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med. 2005;30:4–35.
Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med. 2007;32:146–51.
Popovic J, Morimoto M, Wambold D, Blanck TJ, Rosenberg AD. Current practice of ultrasound-assisted regional anesthesia. Pain Pract. 2006;6:127–34.
Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006;104:368–73.
Choquet O, Capdevila X, Bennourine K, Feugeas JL, Bringuier-Branchereau S, Manelli JC. A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology. 2005;103:1238–45.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Lee, S.H., Jeong, C.W., Lee, H.J. et al. Ultrasound guided obturator nerve block: a single interfascial injection technique. J Anesth 25, 923–926 (2011). https://doi.org/10.1007/s00540-011-1228-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-011-1228-y