title: A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies.
abstract: BACKGROUND
  Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients.
  
  
  METHODS
  The inguinal approach was simulated in five fresh cadavers. Injection of latex was performed in two cadavers. The location of the needle and the extent of latex solution were analyzed. Fifty patients scheduled to undergo arthroscopic knee surgery were randomly assigned to receive obturator nerve block using either the inguinal (n = 25) or the pubic tubercle approach (n = 25).
  
  
  RESULTS
  In all cadavers, the needle was close to the obturator nerve branches, which were surrounded by the latex solution. In the clinical study, visual analog scale pain scores and discomfort of block placement were significantly lower in the inguinal group compared with the pubic tubercle group (P < 0.01). In the inguinal group, there was a significant decrease in block performance time (P < 0.05) and in bolus of propofol and fentanyl used for the procedure (P < 0.01). Twenty minutes after application of the block, adductor strength decrease, occurrence, and location of cutaneous distribution of the obturator nerve were not significantly different between the groups. The incidence of minor complications was significantly increased in the pubic tubercle group (P < 0.05). No major complications were observed.
  
  
  CONCLUSIONS
  The new inguinal approach decreases patient discomfort and pain of block placement as well as the time and sedation and analgesics required for a similar quality of sensory and motor block compared with the pubic tubercle approach.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, La Conception University Hospital, Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Choquet
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
authors.forename: Khaled
authors.initials: K
authors.lastname: Bennourine
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Feugeas
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier-Branchereau
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Manelli
mesh_terms: D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous; D001182:Arthroscopy; D005260:Female; D005267:Femoral Nerve; D005283:Fentanyl; D006801:Humans; D007264:Inguinal Canal; D007717:Knee / Q000601:surgery; D007840:Latex; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D009776:Obturator Nerve; D010147:Pain Measurement; D015742:Propofol
chemical_list: D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; D007840:Latex; D005283:Fentanyl; D015742:Propofol