Ultrasound guided obturator nerve block: a single interfascial injection technique

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)...

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Bibliographic Details
Published in:Journal of anesthesia 2011-12, Vol.25 (6), p.923-926
Main Authors: Lee, Seong Heon, Jeong, Cheol Won, Lee, Hyun Jung, Yoon, Myung Ha, Kim, Woong Mo
Format: Article
Language:English
Subjects:
Aged
Anesthesia, Spinal - methods
Anesthesiology
Clinical Report
Critical Care Medicine
Emergency Medicine
Epinephrine - administration & dosage
Female
Humans
Injections - methods
Intensive
Lidocaine - administration & dosage
Male
Medicine
Medicine & Public Health
Muscle, Skeletal - diagnostic imaging
Muscle, Skeletal - innervation
Nerve Block - instrumentation
Nerve Block - methods
Obturator Nerve - diagnostic imaging
Obturator Nerve - drug effects
Pain Medicine
Peripheral Nerves - diagnostic imaging
Thigh - diagnostic imaging
Ultrasonography, Interventional - methods
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Summary: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.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-011-1228-y