• Reg Anesth Pain Med · May 2007

    Ultrasound-guided obturator nerve block: a preliminary report of a case series.

    • Pablo Escovedo Helayel, Diogo Brüggemann da Conceição, Patrícia Pavei, Julian Alexander Knaesel, and Getúlio Rodrigues de Oliveira Filho.
    • Department of Anesthesiology, Nucleus for Teaching and Research in Regional Anesthesia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil. pehelayel@hotmail.com
    • Reg Anesth Pain Med. 2007 May 1;32(3):221-6.

    Background And ObjectivesObturator-nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the obturator nerve.MethodsA total of 22 patients undergoing anterior cruciate ligament repair had ultrasound-guided obturator-nerve blocks. Needles were directed under real-time ultrasound guidance. Endpoint for injection consisted of identifying contact of the tip of an insulated needle to nerve confirmed by adductor muscles' contraction. Local anesthetic was injected, and block was evaluated within 30 minutes. After that, ultrasound-guided sciatic-femoral blocks were placed for surgical purposes. Data collected included: time required for nerve identification, minimum stimulating current, number of attempts for correct identification, preblock and postblock adductor muscles' strength, sensory-nerve block, and quality of surgical anesthesia.ResultsIn 91% of cases, the obturator nerve was correctly identified on first attempt within 30 +/- 23 seconds, as a hyperechoic flat or lip-shaped structure with internal hypoechoic dots. Minimal intensity of current to nerve stimulation was 0.30 +/- 0.08 mA. All patients exhibited decreases in adductor strength. Sensory territories were variable, with no cutaneous distribution in 32% of the patients. Small-dose opioid supplementation was required in 14% of the patients, but none required general anesthesia to complete surgery.ConclusionsThese preliminary data suggest that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.

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